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Case Nº 053 · Dr. Gabrielle Veillet-Lemay

EC2Change Case FileAtopic dermatitis

053

A 54-year-old female with moderate disease

  • Special sites: head

Case byDr. Gabrielle Veillet-Lemay

3 follow-up visits

At a glanceCase Nº 053

At a glance

A 54-year-old female, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI171
BSA18%1%
Itch NRS103
IGA31
DLQI191

In this file

1
The patientCase Nº 053

54

The patient

year-old female,
moderate disease

  • Special-site involvement

Special sites involved: Head

Previous diagnoses

Atopic dermatitis (childhood onset)

Comorbidities & context

Diabetes Hypercholesterolemia Bipolar mood disorder Atopic dermatitis Otitis externa (staph, klebsiella pneumoniae)
2
Treatment historyCase Nº 053

Treatment history

What came before

Treatment at presentation

Ciprofloxacin, fucibet, dermotic

Previous topical therapy

Protopic, Ectosone, Dermotic, Betamethasone valerate, Fucibet

Previous systemic therapy

Antibiotics (Ciprofloxacin, cephalexin, doxycycline)
3
Disease assessmentCase Nº 053

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

17of 72

BSA

Body surface area

18%of 100%

Itch NRS

Peak pruritus numerical rating scale

10of 10

IGA

Investigator's Global Assessment

3of 4

DLQI

Dermatology Life Quality Index

19of 30

4
Disease assessmentCase Nº 053

Disease assessment

On the skin

Erythema

  • Red / pink

Lichenification

    Site: Auricular/external ear canal

    Excoriation

      Site: Mid forehead/hairline

      5
      Disease assessmentCase Nº 053

      Disease assessment

      How it shaped care

      Impact on diagnosis

      Distribution raised ddx: eczema vs PsO vs ACD

      Impact on severity rating

      Location (head and neck) increased patient's DLQI

      Impact on treatment priorities

      Reduce use of chronic antibiotics, reduce pruritus
      6
      Treatment selectionCase Nº 053

      Treatment selection

      The plan

      Tralokinumab 300 mg SQ q2weeks

      Treatment goals

      Decrease pruritus Reduce need for antibiotics and secondary infection Increase quality of life

      What drove the choice

      Patient has hypercholesterolemia and obesity therefore we were mindful of these comorbidities when selecting therapy
      7
      Follow-upCase Nº 053

      Follow-up · visit 1 of 3

      Under 6 months on treatment

      4 months

      EASI

      Eczema Area and Severity Index

      1of 72

      −16 vs baseline of 17

      BSA

      Body surface area

      1%of 100%

      −17 vs baseline of 18

      Itch NRS

      Peak pruritus numerical rating scale

      3of 10

      −7 vs baseline of 10

      IGA

      Investigator's Global Assessment

      1of 4

      −2 vs baseline of 3

      DLQI

      Dermatology Life Quality Index

      3of 30

      −16 vs baseline of 19

      8
      Follow-upCase Nº 053

      Follow-up · visit 1 of 3

      Visit 1, continued

      Lesions at this visit

      Erythema
      — improved
      Lichenification
      — improved
      Excoriation
      — improved

      Symptoms & daily life

      Pruritus
      — Improved but still present in the ear canals

      Treatment plan

      Treatment continued unchanged

      9
      Follow-upCase Nº 053

      Follow-up · visit 2 of 3

      6 to 12 months on treatment

      10 months

      EASI

      Eczema Area and Severity Index

      5of 72

      −12 vs baseline of 17

      BSA

      Body surface area

      1%of 100%

      −17 vs baseline of 18

      IGA

      Investigator's Global Assessment

      1of 4

      −2 vs baseline of 3

      DLQI

      Dermatology Life Quality Index

      8of 30

      −11 vs baseline of 19

      10
      Follow-upCase Nº 053

      Follow-up · visit 2 of 3

      Visit 2, continued

      Lesions at this visit

      Lichenification
      — Improved
      Excoriation
      — Improved
      Other
      — New rash of the inframammary region. Allergic contact dermatitis (acrylates, balsam of peru, benzoisothiazolinone, fragrance mix, linalool, methyldibromogluteronitrile)

      Symptoms & daily life

      Pruritus
      — Inner ear canal and new eruption of inframammary region
      11
      Follow-upCase Nº 053

      Follow-up · visit 2 of 3

      Visit 2, continued

      Treatment plan

      Treatment modified

      Patient not satisfied
      — Ongoing external ear canal pruritus Vulvar itch (using wet wipes)
      Modification made
      — Applied for qweekly Adtralza but no coverage therefore she was switched to upadacitinib but developed transaminitis, she was then transitioned back to tralokinumab and noted ongoing improvement
      12
      Follow-upCase Nº 053

      Follow-up · visit 3 of 3

      12 months or more on treatment

      3 years

      EASI

      Eczema Area and Severity Index

      1of 72

      −16 vs baseline of 17

      BSA

      Body surface area

      1%of 100%

      −17 vs baseline of 18

      IGA

      Investigator's Global Assessment

      1of 4

      −2 vs baseline of 3

      DLQI

      Dermatology Life Quality Index

      1of 30

      −18 vs baseline of 19

      Lesions at this visit

      Erythema
      — Mild patches of ears - nearly clear
      13
      Follow-upCase Nº 053

      Follow-up · visit 3 of 3

      Visit 3, continued

      Symptoms & daily life

      Pruritus
      — improved

      Treatment plan

      Treatment continued unchanged

      • Patient satisfied
      • Physician satisfied
      14
      OutcomesCase Nº 053

      Outcomes

      Scores over time

      EASI020Baseline: EASI 1717V1: EASI 1V2: EASI 5V3: EASI 11BaselineV1V2V3BSA020Baseline: BSA 18%18%V1: BSA 1%V2: BSA 1%V3: BSA 1%1%BaselineV1V2V3Itch NRS010Baseline: Itch NRS 1010V1: Itch NRS 33BaselineV1V2V3IGA04Baseline: IGA 33V1: IGA 1V2: IGA 1V3: IGA 11BaselineV1V2V3DLQI020Baseline: DLQI 1919V1: DLQI 3V2: DLQI 8V3: DLQI 11BaselineV1V2V3

      V = follow-up visit. Each scale starts at zero.

      15

      A 54-year-old female with moderate atopic dermatitis.

      EC2Change Case File Nº 053

      Contributed by Dr. Gabrielle Veillet-Lemay. Compiled from the physician’s case-builder submission, in their own words.