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Case Nº 045 · Dr. Adam Natsheh

EC2Change Case FileAtopic dermatitis

045

A 72-year-old female with severe disease

  • Elderly
  • Special sites: hands

Case byDr. Adam Natsheh

5 follow-up visits

At a glanceCase Nº 045

At a glance

A 72-year-old female, severe atopic dermatitis

ScoreBaselineLatest visit
EASI110
IGA30
DLQI200

In this file

1
The patientCase Nº 045

72

The patient

year-old female,
severe disease

  • Elderly
  • Special-site involvement

Special sites involved: Hands

Previous diagnoses

- Chronic atopic dermatitis since childhood - Chronic rosacea - Solar/actinic damage of skin - History of actinic keratoses

Comorbidities & context

History of chronic asthma and allergies
2
Treatment historyCase Nº 045

Treatment history

What came before

Treatment at presentation

June 2018 - only using topical Betaderm; no systemics

Previous topical therapy

Has been prescribed numerous topical steroids which caused thinning of her skin. - Betaderm 0.1% BID prn
3
Disease assessmentCase Nº 045

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

11of 72

IGA

Investigator's Global Assessment

3of 4

DLQI

Dermatology Life Quality Index

20of 30

Other assessment

BSA = 10%
4
Disease assessmentCase Nº 045

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation

Lichenification

  • Furrowing

Excoriation

  • Other
5
Disease assessmentCase Nº 045

Disease assessment

On the skin, continued

Pigmentary changes

  • Post-inflammatory hyperpigmentation
6
Disease assessmentCase Nº 045

Disease assessment

How it shaped care

Impact on severity rating

Noted by the physician, no detail given

Impact on treatment selection

Worried about thinning of skin on dorsal hands

Impact on treatment priorities

Special involvement site - hands
- Clear skin without AEs (eg atrophy) - Reduction of pain
Physician goals
7
Disease assessmentCase Nº 045

Disease assessment

How it shaped care, continued

- Clear skin - decreased pain, itching
Patient goals
8
Treatment selectionCase Nº 045

Treatment selection

The plan

Dupixent

Treatment goals

Yes - decreased itching, pain - clear or almost clear skin

What drove the choice

Chronic, recurrent and special site

Safety concerns

Avoid AEs - atrophy, striae
9
Treatment selectionCase Nº 045

Treatment selection

The plan, continued

Target scores

EASI
1
from 11
BSA
0%
Itch NRS
0
IGA
0
from 3
DLQI
0
from 20
10
Follow-upCase Nº 045

Follow-up · visit 1 of 5

6 to 12 months on treatment

EASI

Eczema Area and Severity Index

0of 72

−11 vs baseline of 11

BSA

Body surface area

0%of 100%

Itch NRS

Peak pruritus numerical rating scale

0of 10

IGA

Investigator's Global Assessment

0of 4

−3 vs baseline of 3

DLQI

Dermatology Life Quality Index

0of 30

−20 vs baseline of 20

11
Follow-upCase Nº 045

Follow-up · visit 1 of 5

Visit 1, continued

Lesions at this visit

Pigmentary changes
— Only mild hyperpigmentation
Other
— Clear

Symptoms & daily life

Pruritus
— No itchiness

Treatment plan

Treatment continued unchanged

Modification made
— Continue Dupixent
12
Follow-upCase Nº 045

Follow-up · visit 2 of 5

12 months or more on treatment

EASI

Eczema Area and Severity Index

0of 72

−11 vs baseline of 11

BSA

Body surface area

0%of 100%

Itch NRS

Peak pruritus numerical rating scale

0of 10

IGA

Investigator's Global Assessment

0of 4

−3 vs baseline of 3

DLQI

Dermatology Life Quality Index

0of 30

−20 vs baseline of 20

13
Follow-upCase Nº 045

Follow-up · visit 2 of 5

Visit 2, continued

Lesions at this visit

Other
— Hands continue clear on Dupixent - tried stopping, but recurred

Symptoms & daily life

Pruritus
— Itchiness and dryness of eyes - using eye drops which help

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
14
Follow-upCase Nº 045

Follow-up · visit 3 of 5

12 months or more on treatment

3 years later (2021)

EASI

Eczema Area and Severity Index

0of 72

−11 vs baseline of 11

BSA

Body surface area

0%of 100%

Itch NRS

Peak pruritus numerical rating scale

0of 10

IGA

Investigator's Global Assessment

0of 4

−3 vs baseline of 3

DLQI

Dermatology Life Quality Index

0of 30

−20 vs baseline of 20

15
Follow-upCase Nº 045

Follow-up · visit 3 of 5

Visit 3, continued

Lesions at this visit

Other
— Still clear

Symptoms & daily life

Pruritus
— Itchy dry eyes starting to bother her significantly
16
Follow-upCase Nº 045

Follow-up · visit 3 of 5

Visit 3, continued

Treatment plan

Treatment modified

Patient not satisfied
— Conjunctivitis dry, itchy eyes
Modification made
— DC Dupixent Application for Adtralza - Adtralza request declined by Sunlife due to patient having an EASI score of only 10.6 and not higher than 13 - application re-submitted with note of special site involvement (severe hands) affecting QOL....approved
17
Follow-upCase Nº 045

Follow-up · visit 4 of 5

12 months or more on treatment

Adtralza started May/2022 Follow up Oct/ 2022 = Hands clear, no itchiness, no ocular symptoms

EASI

Eczema Area and Severity Index

0of 72

−11 vs baseline of 11

BSA

Body surface area

0%of 100%

Itch NRS

Peak pruritus numerical rating scale

0of 10

IGA

Investigator's Global Assessment

0of 4

−3 vs baseline of 3

DLQI

Dermatology Life Quality Index

0of 30

−20 vs baseline of 20

18
Follow-upCase Nº 045

Follow-up · visit 4 of 5

Visit 4, continued

Lesions at this visit

Pigmentary changes
— mild hyperpigmentation

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
19
Follow-upCase Nº 045

Follow-up · visit 5 of 5

12 months or more on treatment

April, 2025 - still clear and patient happy

EASI

Eczema Area and Severity Index

0of 72

−11 vs baseline of 11

BSA

Body surface area

0%of 100%

Itch NRS

Peak pruritus numerical rating scale

0of 10

IGA

Investigator's Global Assessment

0of 4

−3 vs baseline of 3

DLQI

Dermatology Life Quality Index

0of 30

−20 vs baseline of 20

20
Follow-upCase Nº 045

Follow-up · visit 5 of 5

Visit 5, continued

Lesions at this visit

Other
— normal exam

Symptoms & daily life

Pruritus
— no pruritus
Impaired social function
— nil Patient is happy and would like to continue

Treatment plan

Treatment continued unchanged

  • Patient satisfied
  • Physician satisfied
21
OutcomesCase Nº 045

Outcomes

Scores over time

EASI020Target 1Baseline: EASI 1111V1: EASI 0V2: EASI 0V3: EASI 0V4: EASI 0V5: EASI 00BaselineV1V2V3V4V5IGA04Target 0Baseline: IGA 33V1: IGA 0V2: IGA 0V3: IGA 0V4: IGA 0V5: IGA 00BaselineV1V2V3V4V5DLQI020Target 0Baseline: DLQI 2020V1: DLQI 0V2: DLQI 0V3: DLQI 0V4: DLQI 0V5: DLQI 00BaselineV1V2V3V4V5

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

22

A 72-year-old female with severe atopic dermatitis.

EC2Change Case File Nº 045

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