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Case Nº 052 · Dr. Amin Bahubeshi

EC2Change Case FileAtopic dermatitis

052

A 54-year-old female with moderate disease

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

Case byDr. Amin Bahubeshi

2 follow-up visits
2 photographs

At a glanceCase Nº 052

At a glance

A 54-year-old female, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI112

In this file

1
The patientCase Nº 052

54

The patient

year-old female,
moderate disease

  • Skin of colour
  • Special-site involvement

Special sites involved: Hands, Head, Neck

Race / ethnicity

Filipina

Fitzpatrick skin type

V

Previous diagnoses

N/A

Comorbidities & context

History of mild eczema for years
2
Treatment historyCase Nº 052

Treatment history

What came before

Treatment at presentation

Betaderm cream

Previous topical therapy

Betaderm cream
3
Disease assessmentCase Nº 052

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

11of 72

Other assessment

estimated
4
Disease assessmentCase Nº 052

Disease assessment

On the skin

Erythema

  • Violaceous

Excoriation

    Site: Face, neck, trunk, arms, hands(works in a kitchen)

    Pigmentary changes

    • Post-inflammatory hyperpigmentation
    5
    Disease assessmentCase Nº 052

    Disease assessment

    How it shaped care

    Impact on diagnosis

    Eczema flare, possible ACD vs ICD component

    Impact on severity rating

    Not severe enough for advanced systemics

    Impact on treatment selection

    Not interested in long term systemics
    Sustainable treatment plan that avoids systemics
    Physician goals
    Quick recovery
    Patient goals
    6
    Treatment selectionCase Nº 052

    Treatment selection

    The plan

    Prednisone 40mg/d x7d with taper Oral bilastine 40-80mg/d BMV 0.1%Cr BID for 2-4 weeks Protopic 0.1%ung BID PRN with taper Discussed skin safe products, moisturizing regularly

    Treatment goals

    The goal was to be able to comfortably perform her duties working in a kitchen

    What drove the choice

    Patient was not interested in long term systemics
    7
    Treatment selectionCase Nº 052

    Treatment selection

    The plan, continued

    Safety concerns

    None
    8
    Follow-upCase Nº 052

    Follow-up · visit 1 of 2

    12 months or more on treatment

    ~14 mos (patient was told to FU PRN if previous plan failed)

    EASI

    Eczema Area and Severity Index

    23of 72

    +12 vs baseline of 11

    BSA

    Body surface area

    19%of 100%

    9
    Follow-upCase Nº 052

    Follow-up · visit 1 of 2

    Visit 1, continued

    Lesions at this visit

    Erythema
    Lichenification
    Excoriation
    Pigmentary changes
    Other
    — EASI score went from mild range to moderate-severe range. EASI ~23

    Symptoms & daily life

    Pruritus
    — Itchy most days of the week
    Work impairment
    — Was worsening at work and improving when away. Patch testing found +ve to Carba mix, Thiuram mix, PPD, 4-terty-butylphenol formaldehyde resin, benzalkonium chloride
    10
    Follow-upCase Nº 052

    Follow-up · visit 1 of 2

    Visit 1, continued

    Treatment plan

    Treatment modified

    Patient not satisfied
    — Extent of dermatitis and the frequency of flares. She was initially clear for 8-9 mos, but eventually had another flare and the severity was worsening significantly.
    Physician not satisfied
    — The level of functional impairment and loss of QoL
    Modification made
    — We changed BMV 0.1%Cr to Clobetasol Applied for tralokinumab
    11
    Follow-upCase Nº 052

    Follow-up · visit 2 of 2

    Under 6 months on treatment

    4mos

    EASI

    Eczema Area and Severity Index

    2of 72

    −9 vs baseline of 11

    Lesions at this visit

    Erythema
    — near resolved
    Excoriation
    — near resolved
    Pigmentary changes
    — near resolved
    12
    Follow-upCase Nº 052

    Follow-up · visit 2 of 2

    Visit 2, continued

    Symptoms & daily life

    Pruritus
    — Minimal, sleep usually uninterrupted
    Work impairment
    — Minimal, requires extra moisturization and gloves at work but less interruption in ability to perform duties

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    • Physician satisfied
    13
    Follow-upCase Nº 052

    Visit 2 photographs

    14
    OutcomesCase Nº 052

    Outcomes

    Scores over time

    EASI030Baseline: EASI 1111V1: EASI 2323V2: EASI 22BaselineV1V2

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

    15

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

    EC2Change Case File Nº 052

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