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Case Nº 035 · Dr. Elena Netchiporouk

EC2Change Case FileAtopic dermatitis

035

A 22-year-old male with severe disease

  • Skin of colour
  • Special sites: head

Case byDr. Elena Netchiporouk

1 follow-up visit
2 photographs

At a glanceCase Nº 035

At a glance

A 22-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI221
BSA15%1%
Itch NRS103
IGA42
DLQI24—

In this file

1
The patientCase Nº 035

22

The patient

year-old male,
severe disease

  • Skin of colour
  • Special-site involvement

Special sites involved: Head

Race / ethnicity

mixed ethnicity (quebec and bangladesh)

Fitzpatrick skin type

4

Previous diagnoses

depression, anxiety

Comorbidities & context

mild asthma
2
Treatment historyCase Nº 035

Treatment history

What came before

Treatment at presentation

tralokinumab

Previous topical therapy

aristocort, betaderm, protopic, other steroids

Previous systemic therapy

dupilumab (failed red face); cyclosporine (gave lab abnormalities)
3
Disease assessmentCase Nº 035

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

22of 72

BSA

Body surface area

15%of 100%

Itch NRS

Peak pruritus numerical rating scale

10of 10

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

24of 30

4
Disease assessmentCase Nº 035

Disease assessment

On the skin

Erythema

  • Violaceous
  • Site

Thickness

    Lichenification

      Excoriation

      • Bleeding

      Pigmentary changes

      • Post-inflammatory hypopigmentation
      5
      Disease assessmentCase Nº 035

      Disease assessment

      How it shaped care

      clear the skin
      Physician goals
      safety, efficacy, interactions
      Patient goals
      6
      Disease assessmentCase Nº 035

      Baseline photographs

      7
      Treatment selectionCase Nº 035

      Treatment selection

      The plan

      tralokinumab prescribed, sample of rinvoq given for transition period

      Treatment goals

      calm the itch and sleep, clear the skin

      Target scores

      EASI
      3
      from 22
      Itch NRS
      1
      from 10
      IGA
      1
      from 4
      DLQI
      3
      from 24
      8
      Follow-upCase Nº 035

      Follow-up · visit 1 of 1

      6 to 12 months on treatment

      7 months

      EASI

      Eczema Area and Severity Index

      1of 72

      −21 vs baseline of 22

      BSA

      Body surface area

      1%of 100%

      −14 vs baseline of 15

      Itch NRS

      Peak pruritus numerical rating scale

      3of 10

      −7 vs baseline of 10

      IGA

      Investigator's Global Assessment

      2of 4

      −2 vs baseline of 4

      Lesions at this visit

      Erythema
      9
      Follow-upCase Nº 035

      Follow-up · visit 1 of 1

      Visit 1, continued

      Symptoms & daily life

      Pruritus
      — mild eyes

      Treatment plan

      Treatment modified

      Modification made
      — desonide x 2 weeks eyelids and then protopic bid as maintenant
      10
      OutcomesCase Nº 035

      Outcomes

      Scores over time

      EASI030Target 3Baseline: EASI 2222V1: EASI 11BaselineV1BSA020Baseline: BSA 15%15%V1: BSA 1%1%BaselineV1Itch NRS010Target 1Baseline: Itch NRS 1010V1: Itch NRS 33BaselineV1IGA04Target 1Baseline: IGA 44V1: IGA 22BaselineV1

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

      11

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

      EC2Change Case File Nº 035

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