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Case Nº 065 · Dr. Parbeer Grewal

EC2Change Case FileAtopic dermatitis

065

A 33-year-old male with moderate disease

  • Skin of colour
  • Special sites: hands, head, neck

Case byDr. Parbeer Grewal

1 follow-up visit
1 photograph

At a glanceCase Nº 065

At a glance

A 33-year-old male, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI204
BSA16%4%
IGA32
DLQI246

In this file

1
The patientCase Nº 065

33

The patient

year-old male,
moderate disease

  • Skin of colour
  • Special-site involvement

Special sites involved: Hands, Head, Neck

Race / ethnicity

Asian

Fitzpatrick skin type

3

Previous diagnoses

Seasonal allergies Mild respiratory induced asthma
2
The patientCase Nº 065

The patient

The patient, continued

Comorbidities & context

Patient wanted therapy to treat allergies, asthma, and AD. Very risk averse, does not want oral therapy. Patient's goal was to mostly clear up their eyelids. Initially applied for lebrikizumab, was rejected, drug plan suggested we choose a JAK inhibitor or dupilumab as our first option.
3
Treatment historyCase Nº 065

Treatment history

What came before

Treatment at presentation

Topical steroids, calcineurin inhibitors, PDE4 inhibitor, dupilumab

Previous topical therapy

Topical steroids, topical calcineurin inhibitors, topical roflumilast, topical ruxolitinib
4
Disease assessmentCase Nº 065

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

20of 72

BSA

Body surface area

16%of 100%

IGA

Investigator's Global Assessment

3of 4

DLQI

Dermatology Life Quality Index

24of 30

5
Disease assessmentCase Nº 065

Disease assessment

On the skin

Erythema

  • Red / pink

Site: Eyelids

Thickness

  • Follicular

Lichenification

  • Nodules

Excoriation

  • Bleeding
6
Disease assessmentCase Nº 065

Disease assessment

On the skin, continued

Pigmentary changes

  • Post-inflammatory hyperpigmentation
7
Disease assessmentCase Nº 065

Disease assessment

How it shaped care

Impact on treatment selection

Eyelid involvement made me want to choose IL13, but insurance limited choices to IL4/13 or JAK inhibitor.

Impact on treatment priorities

Wants to improve skin scores and hyperpigmentation - finds it unsightly.
8
Disease assessmentCase Nº 065

Baseline photographs

9
Treatment selectionCase Nº 065

Treatment selection

The plan

Dupilumab

Treatment goals

Skin to be fairly clear, patient understands full clearance is very hard. Patient also wants to be less uncomfortable - less itch, less runny nose, less wheezing, etc...

Safety concerns

Tolerability of IL4/13 with face and eyelid involvemenet

Target scores

EASI
2
from 20
BSA
3%
from 16%
IGA
1
from 3
10
Follow-upCase Nº 065

Follow-up · visit 1 of 1

Under 6 months on treatment

3 months

EASI

Eczema Area and Severity Index

4of 72

−16 vs baseline of 20

BSA

Body surface area

4%of 100%

−12 vs baseline of 16

IGA

Investigator's Global Assessment

2of 4

−1 vs baseline of 3

DLQI

Dermatology Life Quality Index

6of 30

−18 vs baseline of 24

11
Follow-upCase Nº 065

Follow-up · visit 1 of 1

Visit 1, continued

Lesions at this visit

Erythema
— Reduced
Thickness
— Reduced
Lichenification
— Almost clear
Excoriation
— A few left
Pigmentary changes
— Still has hyperpigmentation

Symptoms & daily life

Pruritus
— Improved, still some itch, especially nocturnal.
12
Follow-upCase Nº 065

Follow-up · visit 1 of 1

Visit 1, continued

Treatment plan

Treatment modified

Physician not satisfied
— Level of improvement and continued itch
Modification made
— Added in phototherapy 2x / week, encouraged use of topicals
13
OutcomesCase Nº 065

Outcomes

Scores over time

EASI020Target 2Baseline: EASI 2020V1: EASI 44BaselineV1BSA020Target 3%Baseline: BSA 16%16%V1: BSA 4%4%BaselineV1IGA04Target 1Baseline: IGA 33V1: IGA 22BaselineV1DLQI030Baseline: DLQI 2424V1: DLQI 66BaselineV1

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

14

A 33-year-old male with moderate atopic dermatitis.

EC2Change Case File Nº 065

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