Case Nº 038 · Dr. Fernando Sanchez

EC2Change Case FileAtopic dermatitis

A 13-year-old female with severe disease

Skin of colour
Advanced systemic failure
Prior JAK inhibitor failure
Prior Dupilumab failure

At a glanceCase Nº 038

At a glance

A 13-year-old female, severe atopic dermatitis

Score	Baseline	Latest visit
EASI	72	—
Itch NRS	10	—
IGA	4	—
DLQI	20	—

In this file

The patientCase Nº 038

The patient

year-old female,
severe disease

Skin of colour
Advanced systemic failure

Race / ethnicity

Indigenous Canadian

Fitzpatrick skin type

III

Previous diagnoses

Atopic Dermatitis

Comorbidities & context

- Severe Peanut Allergy (anaphylaxis) - MRSA colonization

Treatment historyCase Nº 038

Treatment history

What came before

Previous topical therapy

- Protopic 0.1% ointment - Hydrocortisone V 0.2% ointment - Desonide 0.05% ointment - Mometasone 0.1% ointment - Bethamethasone V 0.1% ointment - Flucinolone 0.01% liquid - Clobetasol 0.05% ointment

Previous systemic therapy

- Phototherapy nb-UVB - Prednisone - IVIG infusions - Methotrexate - Upadacitinib - Dupilumab - Cyclosporine

Treatment historyCase Nº 038

Treatment history

What came before, continued

Advanced systemics that failed

JAK inhibitorAdverse event
DupilumabInadequate response

Disease assessmentCase Nº 038

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

72of 72

Itch NRS

Peak pruritus numerical rating scale

10of 10

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

20of 30

Disease assessmentCase Nº 038

Disease assessment

On the skin

Erythema

Red / pink
Violaceous

Site: Erythrodermic presentation

Thickness

Papulation

Lichenification

Site: Extensive lichenification

Excoriation

Bleeding

Site: Trunk & extremities

Disease assessmentCase Nº 038

Disease assessment

On the skin, continued

Pigmentary changes

Post-inflammatory hyperpigmentation

Site: Flexural sites predominantly

Disease assessmentCase Nº 038

Disease assessment

How it shaped care

Impact on severity rating

- Very severe AD recalcitrant to topical/systemics

Impact on treatment selection

Noted by the physician, no detail given

- Overall disease control with objective metrics.

Physician goals

- HRQoL improvement with decent itch control.

Patient goals

Treatment selectionCase Nº 038

Treatment selection

The plan

- Regular loading dose based on the patient's age & weight. - Loading dose of 600 mg (300 mg injections by pre-filled pen x2) - Maintenance of 300 mg every 2 weeks.

Treatment goals

Given the patient’s very severe presentation, clear expectations were established, and patient- and caregiver-centered goals were discussed, focused on controlling pruritus and disease activity.

Treatment selectionCase Nº 038

Treatment selection

The plan, continued

What drove the choice

- Adtralza was preferred over another course of another JAKi (or other immunosuppressant agents) based on the treatments' safety, tolerability, and sustained response for pediatric patients.

Safety concerns

- Needle phobia (pediatric patient). - Worsening facial erythema/dermatitis. - Onset of ocular surface disease.

Follow-upCase Nº 038

Follow-up · visit 1 of 1

Under 6 months on treatment

Patient is 6 weeks into treatment.

Lesions at this visit

Other

Treatment plan

Treatment continued unchanged

Physician satisfied

A 13-year-old female with severe atopic dermatitis.

EC2Change Case File Nº 038

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