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Case Nº 047 · Dr. Michal Martinka

EC2Change Case FileAtopic dermatitis

047

A 36-year-old female with severe disease

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

Case byDr. Michal Martinka

4 follow-up visits

At a glanceCase Nº 047

At a glance

A 36-year-old female, severe atopic dermatitis

ScoreBaselineLatest visit
EASI272
BSA24%5%
IGA41
DLQI251

In this file

1
The patientCase Nº 047

36

The patient

year-old female,
severe disease

  • Skin of colour
  • Special-site involvement

Special sites involved: Hands, Head, Neck

Race / ethnicity

Filipino

Fitzpatrick skin type

3

Previous diagnoses

Atopic dermatitis

Comorbidities & context

NAFLD, hypertension
2
Treatment historyCase Nº 047

Treatment history

What came before

Treatment at presentation

Adtralza

Previous topical therapy

Protopic, Clobetasol, Betaderm

Previous systemic therapy

Multiple courses of prednisone Applied for Dupixent but was not covered
3
Disease assessmentCase Nº 047

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

27of 72

BSA

Body surface area

24%of 100%

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

25of 30

4
Disease assessmentCase Nº 047

Disease assessment

On the skin

Erythema

  • Red / pink

Site: Hands and face

Thickness

  • Papulation

Lichenification

  • Furrowing

Pigmentary changes

  • Post-inflammatory hyperpigmentation
5
Disease assessmentCase Nº 047

Disease assessment

How it shaped care

Impact on diagnosis

She has classic moderate to severe atopic dermatitis since childhood

Impact on severity rating

IGA of 4 due to widespread involvement and chronicity of lesions

Impact on treatment selection

Targeted systemic therapy for above reasons

Impact on treatment priorities

Clear skin; particularly hands and face
6
Disease assessmentCase Nº 047

Disease assessment

How it shaped care, continued

Impact on outcome measure

EASI, IGA, DLQI Subjective report from patient
Clear skin
Physician goals
Improvement of hands and face
Patient goals
7
Treatment selectionCase Nº 047

Treatment selection

The plan

Adtralza + Prednisone for rapid clearance

Treatment goals

Patient wants improvement in itch and clear skin; she is also worried about PIH She wants improvement of face and hands in particular.

What drove the choice

N/A

Safety concerns

N/A
8
Treatment selectionCase Nº 047

Treatment selection

The plan, continued

Target scores

EASI
2
from 27
IGA
1
from 4
9
Follow-upCase Nº 047

Follow-up · visit 1 of 4

Under 6 months on treatment

6 months

EASI

Eczema Area and Severity Index

8of 72

−19 vs baseline of 27

BSA

Body surface area

5%of 100%

−19 vs baseline of 24

IGA

Investigator's Global Assessment

3of 4

−1 vs baseline of 4

DLQI

Dermatology Life Quality Index

11of 30

−14 vs baseline of 25

10
Follow-upCase Nº 047

Follow-up · visit 1 of 4

Visit 1, continued

Lesions at this visit

Erythema
— Improved
Thickness
— Improved
Lichenification
— Improved
Excoriation
— Improved
Pigmentary changes
— Still significant

Symptoms & daily life

Pruritus
— "Less itchy"

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
11
Follow-upCase Nº 047

Follow-up · visit 2 of 4

6 to 12 months on treatment

6

EASI

Eczema Area and Severity Index

6of 72

−21 vs baseline of 27

BSA

Body surface area

6%of 100%

−18 vs baseline of 24

IGA

Investigator's Global Assessment

2of 4

−2 vs baseline of 4

DLQI

Dermatology Life Quality Index

6of 30

−19 vs baseline of 25

12
Follow-upCase Nº 047

Follow-up · visit 2 of 4

Visit 2, continued

Lesions at this visit

Erythema
— Improved
Thickness
— Improved
Lichenification
— Improved
Excoriation
— Improved
Pigmentary changes
— Slowly improving

Symptoms & daily life

Pruritus
— Improved

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
13
Follow-upCase Nº 047

Follow-up · visit 3 of 4

6 to 12 months on treatment

6

EASI

Eczema Area and Severity Index

2of 72

−25 vs baseline of 27

BSA

Body surface area

5%of 100%

−19 vs baseline of 24

IGA

Investigator's Global Assessment

1of 4

−3 vs baseline of 4

DLQI

Dermatology Life Quality Index

2of 30

−23 vs baseline of 25

14
Follow-upCase Nº 047

Follow-up · visit 3 of 4

Visit 3, continued

Lesions at this visit

Erythema
— Improved
Thickness
— Improved
Lichenification
— Improved
Excoriation
— Improved
Pigmentary changes
— Improving

Symptoms & daily life

Pruritus
— Improved

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
15
Follow-upCase Nº 047

Follow-up · visit 4 of 4

6 to 12 months on treatment

6

EASI

Eczema Area and Severity Index

2of 72

−25 vs baseline of 27

BSA

Body surface area

5%of 100%

−19 vs baseline of 24

IGA

Investigator's Global Assessment

1of 4

−3 vs baseline of 4

DLQI

Dermatology Life Quality Index

1of 30

−24 vs baseline of 25

16
Follow-upCase Nº 047

Follow-up · visit 4 of 4

Visit 4, continued

Lesions at this visit

Erythema
— Improved
Thickness
— Improved
Lichenification
— Improved
Excoriation
— Improved
Pigmentary changes
— Improved

Symptoms & daily life

Pruritus
— Improved

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
17
OutcomesCase Nº 047

Outcomes

Scores over time

EASI030Target 2Baseline: EASI 2727V1: EASI 8V2: EASI 6V3: EASI 2V4: EASI 22BaselineV1V2V3V4BSA030Baseline: BSA 24%24%V1: BSA 5%V2: BSA 6%V3: BSA 5%V4: BSA 5%5%BaselineV1V2V3V4IGA04Target 1Baseline: IGA 44V1: IGA 3V2: IGA 2V3: IGA 1V4: IGA 11BaselineV1V2V3V4DLQI030Baseline: DLQI 2525V1: DLQI 11V2: DLQI 6V3: DLQI 2V4: DLQI 11BaselineV1V2V3V4

V = follow-up visit. Each scale starts at zero. Grey line = physician’s target.

18

A 36-year-old female with severe atopic dermatitis.

EC2Change Case File Nº 047

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