Library

Case Nº 057 · Dr. Angela Law

EC2Change Case FileAtopic dermatitis

057

A 28-year-old male with severe disease

  • Skin of colour
  • Advanced systemic failure
  • Special sites: head
  • Prior JAK inhibitor failure

Case byDr. Angela Law

1 follow-up visit
2 photographs

At a glanceCase Nº 057

At a glance

A 28-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI18—
BSA15%—
IGA3—

In this file

1
The patientCase Nº 057

28

The patient

year-old male,
severe disease

  • Skin of colour
  • Special-site involvement
  • Advanced systemic failure

Special sites involved: Head

Race / ethnicity

Filipino

Fitzpatrick skin type

IV

Previous diagnoses

Atopic dermatitis

Comorbidities & context

binge drinking (alcohol)
2
Treatment historyCase Nº 057

Treatment history

What came before

Treatment at presentation

Betaderm 0.1% cream, Protopic ointment 0.1%

Previous topical therapy

Betaderm 0.1% cream- using prn Protopic ointment 0.1%- using pro

Previous systemic therapy

nbUVB phototherapy- ineffective methotrexate- elevation of liver enzymes upadacitinib- elevation of liver enzymes Tralokinumab
3
Treatment historyCase Nº 057

Treatment history

What came before, continued

Advanced systemics that failed

  • JAK inhibitorAdverse event
4
Disease assessmentCase Nº 057

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

18of 72

BSA

Body surface area

15%of 100%

IGA

Investigator's Global Assessment

3of 4

5
Disease assessmentCase Nº 057

Disease assessment

On the skin

Erythema

  • Red / pink

Site: face

Thickness

    Site: face

    Lichenification

      Site: face, hands, arms, legs

      Excoriation

        Site: torso, face

        6
        Disease assessmentCase Nº 057

        Disease assessment

        On the skin, continued

        Pigmentary changes

        • Post-inflammatory hypopigmentation
        7
        Disease assessmentCase Nº 057

        Disease assessment

        How it shaped care

        Impact on treatment selection

        challenges with compliance, concern with immunosuppression
        8
        Disease assessmentCase Nº 057

        Baseline photographs

        L arm/ hand
        popliteal fossa
        9
        Treatment selectionCase Nº 057

        Treatment selection

        The plan

        We discussed initiating oral cyclosporine 100mg BID

        Treatment goals

        Better control of disease and improvement in itch, particularly facial involvement

        Safety concerns

        Cannot inject needles on his own Binge drinking compliance concerns
        10
        Follow-upCase Nº 057

        Follow-up · visit 1 of 1

        Under 6 months on treatment

        2months

        Lesions at this visit

        Erythema
        — improvement in overall inflammation and erythema
        Lichenification
        — decreased

        Treatment plan

        Treatment continued unchanged

        • Patient satisfied
        11

        A 28-year-old male with severe atopic dermatitis.

        EC2Change Case File Nº 057

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