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Case Nº 017 · Dr. Eric Wong

EC2Change Case FileAtopic dermatitis

017

A 40-year-old male with severe disease

  • Skin of colour
  • Advanced systemic failure
  • Special sites: hands, head, neck
  • Prior JAK inhibitor failure
  • Prior Dupilumab failure

Case byDr. Eric Wong

1 follow-up visit

At a glanceCase Nº 017

At a glance

A 40-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI24—
BSA30%—
IGA3—
DLQI16—

In this file

1
The patientCase Nº 017

40

The patient

year-old male,
severe disease

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

Special sites involved: Hands, Head, Neck

Race / ethnicity

Filipino

Fitzpatrick skin type

III

Previous diagnoses

asthma, seasonal allergies

Comorbidities & context

none
2
Treatment historyCase Nº 017

Treatment history

What came before

Treatment at presentation

Adtralza, clobetasol, Eucrisa

Previous topical therapy

elides

Previous systemic therapy

cyclosporine- length of time restriction Imuran-developed pancytopenia Methotrexate- not responsive IM Kenalog prednisone
3
Treatment historyCase Nº 017

Treatment history

What came before, continued

Advanced systemics that failed

  • JAK inhibitorAdverse event
  • DupilumabInadequate response
4
Disease assessmentCase Nº 017

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

24of 72

BSA

Body surface area

30%of 100%

IGA

Investigator's Global Assessment

3of 4

DLQI

Dermatology Life Quality Index

16of 30

5
Disease assessmentCase Nº 017

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation
  • Site

Lichenification

    Site: face, neck

    Excoriation

    • Bleeding
    6
    Disease assessmentCase Nº 017

    Disease assessment

    On the skin, continued

    Pigmentary changes

    • Post-inflammatory hyperpigmentation
    7
    Disease assessmentCase Nº 017

    Disease assessment

    How it shaped care

    Impact on treatment selection

    pt unhappy with face even though body improved
    8
    Treatment selectionCase Nº 017

    Treatment selection

    The plan

    Altralza with topicals

    Treatment goals

    patient was happy with body but unhappy with eyelids, periorbital area, face and neck. Affected his vision and view. Also facial skin affected him as visibly seen from other people.

    What drove the choice

    none

    Safety concerns

    none
    9
    Treatment selectionCase Nº 017

    Treatment selection

    The plan, continued

    Target scores

    EASI
    2
    from 24
    10
    Follow-upCase Nº 017

    Follow-up · visit 1 of 1

    6 to 12 months on treatment

    Lesions at this visit

    Erythema
    Thickness
    Lichenification

    Symptoms & daily life

    Pruritus

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    11

    A 40-year-old male with severe atopic dermatitis.

    EC2Change Case File Nº 017

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