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Case Nº 046 · Dr. Toni Burbidge

EC2Change Case FileAtopic dermatitis

046

A 41-year-old female with moderate disease

  • Advanced systemic failure
  • Prior Dupilumab failure

Case byDr. Toni Burbidge

1 follow-up visit

At a glanceCase Nº 046

At a glance

A 41-year-old female, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI172
BSA14%1%

In this file

1
The patientCase Nº 046

41

The patient

year-old female,
moderate disease

  • Advanced systemic failure

Previous diagnoses

Healthy

Comorbidities & context

Environmental allergies
2
Treatment historyCase Nº 046

Treatment history

What came before

Treatment at presentation

dupilumab 300mg sc weekly protopic ointment for face and neck lyderm cream for body

Previous systemic therapy

Dupilumab 300mg sc injections -discontinued due to worsening head and neck dermatitis while on treatment

Advanced systemics that failed

  • DupilumabAdverse event
3
Disease assessmentCase Nº 046

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

17of 72

BSA

Body surface area

14%of 100%

4
Disease assessmentCase Nº 046

Disease assessment

On the skin

Erythema

  • Red / pink

Site: Face, neck

Lichenification

    Site: Neck, periorbital, forehead (prior to starting tralo)

    5
    Disease assessmentCase Nº 046

    Disease assessment

    How it shaped care

    Impact on treatment selection

    Tralo chosen to resolve the head and neck dermatitis
    Found facial involvement disfiguring
    Patient goals
    6
    Treatment selectionCase Nº 046

    Treatment selection

    The plan

    Dupilumab 300mg sc was switched to tralokinumab 300mg sc Her standing topicals were left unchanged

    Treatment goals

    Improve head and neck dermatitis

    What drove the choice

    The presence of worsening head and neck dermatitis that would not improve with protopic lead me to switch her systemic agent to tralokinumab
    7
    Treatment selectionCase Nº 046

    Treatment selection

    The plan, continued

    Target scores

    EASI
    2
    from 17
    BSA
    1%
    from 14%
    Itch NRS
    0
    IGA
    0
    DLQI
    2
    8
    Follow-upCase Nº 046

    Follow-up · visit 1 of 1

    Under 6 months on treatment

    3 months

    EASI

    Eczema Area and Severity Index

    2of 72

    −15 vs baseline of 17

    BSA

    Body surface area

    1%of 100%

    −13 vs baseline of 14

    DLQI

    Dermatology Life Quality Index

    5of 30

    9
    Follow-upCase Nº 046

    Follow-up · visit 1 of 1

    Visit 1, continued

    Lesions at this visit

    Erythema
    — Minimal to none, a little on arms, but face is now nearly clear
    Thickness
    — None

    Symptoms & daily life

    Pruritus
    — Very mild flares to extremities. Much improved
    Work impairment
    — None remaining
    Impaired social function
    — Much improved, much less self conscious regarding her facial skin

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    • Physician satisfied
    10
    OutcomesCase Nº 046

    Outcomes

    Scores over time

    EASI020Target 2Baseline: EASI 1717V1: EASI 22BaselineV1BSA020Target 1%Baseline: BSA 14%14%V1: BSA 1%1%BaselineV1

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

    11

    A 41-year-old female with moderate atopic dermatitis.

    EC2Change Case File Nº 046

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