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Case Nº 031 · Dr. Carrie Lynde

EC2Change Case FileAtopic dermatitis

031

A 74-year-old female with moderate disease

  • Elderly

Case byDr. Carrie Lynde

1 follow-up visit

At a glanceCase Nº 031

At a glance

A 74-year-old female, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI17—
BSA15%—
Itch NRS81
DLQI23—

In this file

1
The patientCase Nº 031

74

The patient

year-old female,
moderate disease

  • Elderly

Previous diagnoses

Atopic dermatitis

Comorbidities & context

Hypertension Hyperlipidemia History of thyroid cancer
2
Treatment historyCase Nº 031

Treatment history

What came before

Treatment at presentation

Propaderm cream Protopic ointment NbUVB

Previous topical therapy

Lyderm ointment Betaderm ointment Hydroval
3
Disease assessmentCase Nº 031

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

17of 72

BSA

Body surface area

15%of 100%

Itch NRS

Peak pruritus numerical rating scale

8of 10

DLQI

Dermatology Life Quality Index

23of 30

4
Disease assessmentCase Nº 031

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation

Lichenification

    Site: Arms and legs

    Excoriation

      Site: Arms, bruising

      5
      Disease assessmentCase Nº 031

      Disease assessment

      On the skin, continued

      Pigmentary changes

      • Post-inflammatory hyperpigmentation
      6
      Disease assessmentCase Nº 031

      Disease assessment

      How it shaped care

      Impact on diagnosis

      Showed classic clinical features of ad so easy to diagnose

      Impact on severity rating

      Severe due to body surface and thick itchy lesions

      Impact on treatment selection

      Need for systemic therapy

      Impact on treatment priorities

      Need for more than topical therapy

      Impact on outcome measure

      Itch improvement will be critical
      7
      Disease assessmentCase Nº 031

      Disease assessment

      How it shaped care, continued

      Healing thickened crusted skin lesions, reducing itch
      Physician goals
      Improving itch and clearing skin
      Patient goals
      8
      Treatment selectionCase Nº 031

      Treatment selection

      The plan

      Adtralza 300 mg sc q2 weeks Protopic Ung bid Zoryve cr qhs Gentle moisturizer and cleanser

      Treatment goals

      Less itch Less visible lesions More sleep

      What drove the choice

      Risk factors for cardiac disease, dvt/pe, cancer history

      Safety concerns

      No concerns with adtralza
      9
      Treatment selectionCase Nº 031

      Treatment selection

      The plan, continued

      Target scores

      Itch NRS
      1
      from 8
      IGA
      1
      10
      Follow-upCase Nº 031

      Follow-up · visit 1 of 1

      Under 6 months on treatment

      3 months

      Itch NRS

      Peak pruritus numerical rating scale

      1of 10

      −7 vs baseline of 8

      IGA

      Investigator's Global Assessment

      1of 4

      Lesions at this visit

      Lichenification
      — Improved, not as thick
      Excoriation
      — Improved

      Symptoms & daily life

      Pruritus
      — Improved
      11
      Follow-upCase Nº 031

      Follow-up · visit 1 of 1

      Visit 1, continued

      Treatment plan

      Treatment continued unchanged

      • Patient satisfied
      • Physician satisfied
      12
      OutcomesCase Nº 031

      Outcomes

      Scores over time

      Itch NRS010Target 1Baseline: Itch NRS 88V1: Itch NRS 11BaselineV1

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

      13

      A 74-year-old female with moderate atopic dermatitis.

      EC2Change Case File Nº 031

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