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Case Nº 041 · Dr. Jennifer Tran

EC2Change Case FileAtopic dermatitis

041

A 33-year-old male with severe disease

  • Skin of colour
  • Special sites: hands, head

Case byDr. Jennifer Tran

1 follow-up visit

At a glanceCase Nº 041

At a glance

A 33-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI22—
BSA20%—
IGA4—

In this file

1
The patientCase Nº 041

33

The patient

year-old male,
severe disease

  • Skin of colour
  • Special-site involvement

Special sites involved: Hands, Head

Race / ethnicity

Asian

Fitzpatrick skin type

IV

Previous diagnoses

Atopic dermatitis

Comorbidities & context

Connective tissue disease - actively being worked up by Rheumatology
2
Treatment historyCase Nº 041

Treatment history

What came before

Treatment at presentation

Topicals and prednisone Then started Dupixent in May 2021

Previous topical therapy

Elidel, Protopic, steroid creams

Previous systemic therapy

Dupixent
3
Disease assessmentCase Nº 041

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

22of 72

BSA

Body surface area

20%of 100%

IGA

Investigator's Global Assessment

4of 4

4
Disease assessmentCase Nº 041

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

    Lichenification

      Excoriation

        Pigmentary changes

        • Post-inflammatory hyperpigmentation
        5
        Disease assessmentCase Nº 041

        Disease assessment

        On the skin, continued

        Beyond the skin

        • Pruritus
        • Impaired social function
        6
        Disease assessmentCase Nº 041

        Disease assessment

        How it shaped care

        Impact on severity rating

        Severe skin disease

        Impact on treatment selection

        Topicals insufficient, felt like we needed a systemic
        My goal is to clear patients
        Physician goals
        She just wanted to have normal nails again
        Patient goals
        7
        Treatment selectionCase Nº 041

        Treatment selection

        The plan

        Switch to Adtralza (pt preference to stay within class, did not like jak inhibitor side effects)

        Treatment goals

        Clear or almost clear skin Decreased pruritus

        What drove the choice

        Patient had severe disease, and was started in Dupixent, but it wasn't controlling his eczema on the face and hands Considered Rinvoq vs Adtralza
        8
        Treatment selectionCase Nº 041

        Treatment selection

        The plan, continued

        Safety concerns

        Did not want to worsen his underlying connective tissue disease
        9
        Follow-upCase Nº 041

        Follow-up · visit 1 of 1

        Under 6 months on treatment

        3 months

        Lesions at this visit

        Erythema
        — Stable
        Thickness
        — Stable
        Lichenification
        — Stable
        Excoriation
        — Stable
        Other
        — Patient reports 2 flares over the past year.

        Symptoms & daily life

        Pruritus
        — Well-controlled
        10
        Follow-upCase Nº 041

        Follow-up · visit 1 of 1

        Visit 1, continued

        Treatment plan

        Treatment continued unchanged

        • Patient satisfied
        • Physician satisfied
        11

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

        EC2Change Case File Nº 041

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