Library

Case Nº 067 · Dr. Ivan Litvinov

EC2Change Case FileAtopic dermatitis

067

A 12-year-old male with severe disease

  • Skin of colour

Case byDr. Ivan Litvinov

1 follow-up visit
3 photographs

At a glanceCase Nº 067

At a glance

A 12-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI3710
BSA58%18%
Itch NRS73
IGA42

In this file

1
The patientCase Nº 067

12

The patient

year-old male,
severe disease

  • Skin of colour

Race / ethnicity

Indigenous

Fitzpatrick skin type

4

Previous diagnoses

None

Comorbidities & context

None
2
Treatment historyCase Nº 067

Treatment history

What came before

Treatment at presentation

Desonide and cream (moisturizer)

Previous topical therapy

Desonide and cream (moisturizer)
3
Disease assessmentCase Nº 067

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

37of 72

BSA

Body surface area

58%of 100%

Itch NRS

Peak pruritus numerical rating scale

7of 10

IGA

Investigator's Global Assessment

4of 4

4
Disease assessmentCase Nº 067

Disease assessment

On the skin

Erythema

  • Red / pink
  • Violaceous

Thickness

  • Papulation

Lichenification

  • Nodules
  • Furrowing

Excoriation

  • Bleeding
5
Disease assessmentCase Nº 067

Disease assessment

On the skin, continued

Pigmentary changes

  • Post-inflammatory hypopigmentation
6
Disease assessmentCase Nº 067

Disease assessment

How it shaped care

Impact on diagnosis

Severe AD
7
Disease assessmentCase Nº 067

Baseline photographs

8
Disease assessmentCase Nº 067

Baseline photographs

9
Treatment selectionCase Nº 067

Treatment selection

The plan

Dupilumab + EMLA Betaderm for severe eczema sites on body and elidel for face and sensitive skin Mupirocin for any cracked skin Aquaphor oint BID for all affected skin

Treatment goals

Improvement of quality of life

What drove the choice

Control symptoms, prevent infection.
10
Treatment selectionCase Nº 067

Treatment selection

The plan, continued

Safety concerns

Considering pediatric age the safest treatment was offered. the patient is based in Nunavik where no NB-UVB is available.

Target scores

EASI
45
from 37
BSA
67%
from 58%
Itch NRS
7
from 7
IGA
4
from 4
DLQI
19
11
Follow-upCase Nº 067

Follow-up · visit 1 of 1

Under 6 months on treatment

6 weeks

EASI

Eczema Area and Severity Index

10of 72

−27 vs baseline of 37

BSA

Body surface area

18%of 100%

−40 vs baseline of 58

Itch NRS

Peak pruritus numerical rating scale

3of 10

−4 vs baseline of 7

IGA

Investigator's Global Assessment

2of 4

−2 vs baseline of 4

DLQI

Dermatology Life Quality Index

9of 30

12
Follow-upCase Nº 067

Follow-up · visit 1 of 1

Visit 1, continued

Lesions at this visit

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

Symptoms & daily life

Pruritus
— Improved
Impaired social function
— Improved

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
13
OutcomesCase Nº 067

Outcomes

Scores over time

EASI050Target 45Baseline: EASI 3737V1: EASI 1010BaselineV1BSA072Target 67%Baseline: BSA 58%58%V1: BSA 18%18%BaselineV1Itch NRS010Target 7Baseline: Itch NRS 77V1: Itch NRS 33BaselineV1IGA04Target 4Baseline: IGA 44V1: IGA 22BaselineV1

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

14

A 12-year-old male with severe atopic dermatitis.

EC2Change Case File Nº 067

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