Case Nº 042 · Dr. Zaki Taher

EC2Change Case FileAtopic dermatitis

A 30-year-old male with severe disease

Special sites: head, genitals

At a glanceCase Nº 042

At a glance

A 30-year-old male, severe atopic dermatitis

Score	Baseline	Latest visit
EASI	52	12
BSA	30%	5%
IGA	4	1
DLQI	24	8

In this file

The patientCase Nº 042

The patient

year-old male,
severe disease

Special-site involvement

Special sites involved: Head, Genitals

Previous diagnoses

30% body surface area involvement Severe Eczematous dermatitis

Comorbidities & context

Obese, bmi 40

Treatment historyCase Nº 042

Treatment history

What came before

Treatment at presentation

hyroxyzine

Previous topical therapy

Hyroval Lyceum Betaderm Clobetasol (used for a prolonged period on the face)

Previous systemic therapy

Prednisone Phototherapy

Disease assessmentCase Nº 042

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

52of 72

BSA

Body surface area

30%of 100%

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

24of 30

Disease assessmentCase Nº 042

Disease assessment

On the skin

Erythema

Red / pink
Violaceous

Thickness

Papulation

Site: facial and periorbital

Lichenification

Nodules
Furrowing

Excoriation

Bleeding

Disease assessmentCase Nº 042

Disease assessment

On the skin, continued

Pigmentary changes

Post-inflammatory hyperpigmentation

Disease assessmentCase Nº 042

Disease assessment

How it shaped care

Impact on diagnosis

Very severe debilitating disease

Impact on severity rating

extremely severe

Impact on treatment priorities

expedite the use of advanced therapeutics

less reliant on repeated courses of prednisone

Physician goals

better sleep, less itchy

Patient goals

Treatment selectionCase Nº 042

Treatment selection

The plan

Initially trialled with prendnisone and supplemented with phototherapy while paperwork and application to Adtralza was made

Treatment goals

Yes. The goal was to have better sleep, less time off work and to feel more functional. Very young man who felt very affected in personal life and relationships were very limited by severity of disease.

What drove the choice

I felt that the safety profile and patient goals were very compatible with the therapeutic choice

Treatment selectionCase Nº 042

Treatment selection

The plan, continued

Safety concerns

None

Target scores

EASI: 20; from 52
BSA: 9%; from 30%
IGA: 2; from 4
DLQI: 10; from 24

Follow-upCase Nº 042

Follow-up · visit 1 of 1

Under 6 months on treatment

EASI

Eczema Area and Severity Index

12of 72

−40 vs baseline of 52

BSA

Body surface area

5%of 100%

−25 vs baseline of 30

IGA

Investigator's Global Assessment

1of 4

−3 vs baseline of 4

DLQI

Dermatology Life Quality Index

8of 30

−16 vs baseline of 24

Follow-upCase Nº 042

Follow-up · visit 1 of 1

Visit 1, continued

Lesions at this visit

Erythema: — minimal Mild residual more seb derm like clinical findings on forehead and scalp
Thickness: — reduced thickness of lesions
Lichenification: — new and different branny scale on the forehead and scalp
Excoriation: — much improved, attributed to sleeping better through the night
Pigmentary changes: — stabilized, not fully recovered but improved

Follow-upCase Nº 042

Follow-up · visit 1 of 1

Visit 1, continued

Symptoms & daily life

Pruritus: — minimal and able to sleep through the night
Work impairment: — functional with less days at work
Impaired social function: — More confident and willing to get out and mingle

Treatment plan

Treatment continued unchanged

Patient satisfied
Physician satisfied

OutcomesCase Nº 042

Outcomes

Scores over time

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

A 30-year-old male with severe atopic dermatitis.

EC2Change Case File Nº 042

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