Case Nº 018 · Dr. Dave Adam

EC2Change Case FileAtopic dermatitis

A 54-year-old female with severe disease

Special sites: hands

At a glanceCase Nº 018

At a glance

A 54-year-old female, severe atopic dermatitis

Score	Baseline	Latest visit
IGA	4	0

In this file

The patientCase Nº 018

The patient

year-old female,
severe disease

Special-site involvement

Special sites involved: Hands

Previous diagnoses

Severe Hand Dermatitis in the setting of atopic dermatitis, PMH significant for Generalized anxiety disorder and menopause

Comorbidities & context

comorbidities were not relevant or impact diagnosis and treatment

Treatment historyCase Nº 018

Treatment history

What came before

Treatment at presentation

patient after seeing me was started on alitretinoin 30 mg OD ,

Previous topical therapy

failed clobetasol lyderm and betnovate all applied twice daily and all used for 6 weeks or more continuously without adequate response.

Previous systemic therapy

Was also tried on doxepin 10 mg 1-2 caps qhs in the past

Disease assessmentCase Nº 018

Disease assessment

Severity at baseline

IGA

Investigator's Global Assessment

4of 4

Disease assessmentCase Nº 018

Disease assessment

On the skin

Erythema

Red / pink

Thickness

Papulation

Treatment selectionCase Nº 018

Treatment selection

The plan

Alitretinoin 30 mg OD

Treatment goals

Control vesicular outbreaks on the hands. Control the itch

What drove the choice

patient had good insurance, was not of child-bearing age and had failed topical therapy. She was not able to attend phototherapy. She had no comorbidities that would preclude use of alitretinoin and had disease that was largely limited to the hands.

Safety concerns

none

Treatment selectionCase Nº 018

Treatment selection

The plan, continued

Target scores

IGA: 1; from 4

Follow-upCase Nº 018

Follow-up · visit 1 of 2

Under 6 months on treatment

clear by 2 months by month 3 had recurrent vesicular eruption complicated by staph. Was also suffering from headaches Had to stop alitretinoin and initiated more topical steroids and cephalexin

IGA

Investigator's Global Assessment

4of 4

Unchanged from baseline

DLQI

Dermatology Life Quality Index

20of 30

Lesions at this visit

Other: — vesicular eruption with secondary infection

Follow-upCase Nº 018

Follow-up · visit 1 of 2

Visit 1, continued

Symptoms & daily life

Work impairment: — Admin job at OPG and uses mouse with right hand which is the even more severe of the two hands
Impaired social function: — Cant shake hands so limited ability to socialize or network at the job and at home

Follow-upCase Nº 018

Follow-up · visit 1 of 2

Visit 1, continued

Treatment plan

Treatment modified

Patient not satisfied: — side effects and lack of efficacy
Physician not satisfied: — side effects and lack of efficacy
Modification made: — Patient was switched to Adtralza 300 mg q 2 weekly after loading dose. Was given pred taper as well

Follow-upCase Nº 018

Follow-up · visit 2 of 2

6 to 12 months on treatment

4 months after starting adtralza

IGA

Investigator's Global Assessment

0of 4

−4 vs baseline of 4

DLQI

Dermatology Life Quality Index

0of 30

Lesions at this visit

Other: — clear

Symptoms & daily life

Pruritus: — none
Work impairment: — none
Impaired social function: — none

Follow-upCase Nº 018

Follow-up · visit 2 of 2

Visit 2, continued

Treatment plan

Treatment continued unchanged

Patient satisfied
Physician satisfied

OutcomesCase Nº 018

Outcomes

Scores over time

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

A 54-year-old female with severe atopic dermatitis.

EC2Change Case File Nº 018

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