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Case Nº 043 · Dr. Annie Langley

EC2Change Case FileAtopic dermatitis

043

A 22-year-old female with severe disease

  • Special sites: hands, head, neck

Case byDr. Annie Langley

1 follow-up visit
3 photographs

At a glanceCase Nº 043

At a glance

A 22-year-old female, severe atopic dermatitis

ScoreBaselineLatest visit
EASI150
BSA25%0%
Itch NRS60
DLQI21—

In this file

1
The patientCase Nº 043

22

The patient

year-old female,
severe disease

  • Special-site involvement

Special sites involved: Hands, Head, Neck

Previous diagnoses

atopic dermatitis asthma seasonal allergies

Comorbidities & context

asthma seasonal allergies
2
Treatment historyCase Nº 043

Treatment history

What came before

Treatment at presentation

tralokinumab 300mg SC q 2wk

Previous topical therapy

Betamethasone valerate 0.1% ointment BID x years - ineffective Pimecrolimus 1% cream BID x years - ineffective Tacrolimus 0.1% ointment BID x years - ineffective

Previous systemic therapy

Rupatidine 10mg PO BID x years - ineffective Cetirizine 20mg PO QHS x years - ineffective
3
Disease assessmentCase Nº 043

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

15of 72

BSA

Body surface area

25%of 100%

Itch NRS

Peak pruritus numerical rating scale

6of 10

DLQI

Dermatology Life Quality Index

21of 30

4
Disease assessmentCase Nº 043

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation

Lichenification

    Excoriation

      Pigmentary changes

      • Post-inflammatory hyperpigmentation
      5
      Disease assessmentCase Nº 043

      Disease assessment

      How it shaped care

      Impact on treatment priorities

      facial and hand involvement severely impacted QOL
      to clear visible parts of skin (face, hands)
      Patient goals
      6
      Disease assessmentCase Nº 043

      Baseline photographs

      7
      Treatment selectionCase Nº 043

      Treatment selection

      The plan

      Tralokinumab 300mg SC q 2 weeks

      Treatment goals

      EASI-75 clear face and hands NRS 0-1

      What drove the choice

      fast, durable response

      Safety concerns

      none
      8
      Follow-upCase Nº 043

      Follow-up · visit 1 of 1

      Under 6 months on treatment

      EASI

      Eczema Area and Severity Index

      0of 72

      −15 vs baseline of 15

      BSA

      Body surface area

      0%of 100%

      −25 vs baseline of 25

      Itch NRS

      Peak pruritus numerical rating scale

      0of 10

      −6 vs baseline of 6

      Lesions at this visit

      Other
      — skin completely clear, patient reported complete clearance by 6 weeks
      9
      Follow-upCase Nº 043

      Follow-up · visit 1 of 1

      Visit 1, continued

      Symptoms & daily life

      Pruritus
      — resolved
      Impaired social function
      — resolved

      Treatment plan

      Treatment continued unchanged

      • Patient satisfied
      • Physician satisfied
      10
      Follow-upCase Nº 043

      Visit 1 photographs

      "confident girl smiling"
      11
      OutcomesCase Nº 043

      Outcomes

      Scores over time

      EASI020Baseline: EASI 1515V1: EASI 00BaselineV1BSA030Baseline: BSA 25%25%V1: BSA 0%0%BaselineV1Itch NRS010Baseline: Itch NRS 66V1: Itch NRS 00BaselineV1

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

      12

      A 22-year-old female with severe atopic dermatitis.

      EC2Change Case File Nº 043

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