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Case Nº 058 · Dr. Larry Cheung

EC2Change Case FileAtopic dermatitis

058

A 44-year-old male with severe disease

  • Skin of colour
  • Special sites: hands, head, neck, genitals

Case byDr. Larry Cheung

1 follow-up visit

At a glanceCase Nº 058

At a glance

A 44-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI54—
IGA4—

In this file

1
The patientCase Nº 058

44

The patient

year-old male,
severe disease

  • Skin of colour
  • Special-site involvement

Special sites involved: Hands, Head, Neck, Genitals

Race / ethnicity

East or Southeast Asian

Fitzpatrick skin type

III / IV

Previous diagnoses

Asthma, Chickenpox, Eczema

Comorbidities & context

URTI Eczema herpeticum Glaucomatocyclitic crisis vs. HSV keratitis
2
Treatment historyCase Nº 058

Treatment history

What came before

Treatment at presentation

Tralokinumab and topicals ( corticosteroid, calcineurin inhibitor, and PDE4i)

Previous topical therapy

Tacrolimus 0.1% oint., Roflumilast 0.3% foam or cream Triamcinolone 0.1% cream, Betamethasone valerate, Clobetasol, Halobetasol

Previous systemic therapy

MTX 20 mg 1x/week Upadacitinib 30 mg QD
3
Disease assessmentCase Nº 058

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

54of 72

IGA

Investigator's Global Assessment

4of 4

4
Disease assessmentCase Nº 058

Disease assessment

On the skin

Erythema

    Lichenification

      Excoriation

        Pigmentary changes

          5
          Disease assessmentCase Nº 058

          Disease assessment

          How it shaped care

          Impact on treatment selection

          Noted by the physician, no detail given
          6
          Treatment selectionCase Nº 058

          Treatment selection

          The plan

          Tralokinumab 300 mg every other week

          Treatment goals

          This is one of my most severe eczema patients.

          What drove the choice

          Access

          Safety concerns

          Risks of ocular s/e and of infx
          7
          Follow-upCase Nº 058

          Follow-up · visit 1 of 1

          Under 6 months on treatment

          3-4 months after starting MTX Same with Upadacitinib

          Lesions at this visit

          Erythema
          — Inadequate response to MTX Responded to Upadacitinib, but response started to wane
          Lichenification
          — Inadequate response to MTX Responded to Upadacitinib, but response started to wane
          Excoriation
          — Inadequate response to MTX Responded to Upadacitinib, but response started to wane
          8
          Follow-upCase Nº 058

          Follow-up · visit 1 of 1

          Visit 1, continued

          Treatment plan

          Treatment modified

          Modification made
          — Ophthalmology advised against Upadacitinib because of risk of infx. Because of risk of ocular s/e with Dupilumab, Tralokinumab was favoured.
          9

          A 44-year-old male with severe atopic dermatitis.

          EC2Change Case File Nº 058

          Contributed by Dr. Larry Cheung. Compiled from the physician’s case-builder submission, in their own words.