Case Nº 068 · Dr. Ivan Litvinov

EC2Change Case FileAtopic dermatitis

A 27-year-old male with severe disease

Skin of colour

At a glanceCase Nº 068

At a glance

A 27-year-old male, severe atopic dermatitis

Score	Baseline	Latest visit
EASI	38	7
BSA	79%	10%
Itch NRS	7	0
IGA	4	1
DLQI	18	5

In this file

The patientCase Nº 068

The patient

year-old male,
severe disease

Skin of colour

Race / ethnicity

Asian

Previous diagnoses

27 year-old Asian male student presenting with severe eczema since 2018. He was only using moisturizers, which did not control his symptoms. More than >60% of his BSA was affected.

Treatment historyCase Nº 068

Treatment history

What came before

Treatment at presentation

Started on Cyclosporin, NB-UVB phototherapy and topical steroids in Nov with follow up in ~6 weeks. Patient returned in December still with significant eczema.

Previous topical therapy

Topical Steroids, NBUVB (did not undertake)

Previous systemic therapy

Cyclosporin

Disease assessmentCase Nº 068

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

38of 72

BSA

Body surface area

79%of 100%

Itch NRS

Peak pruritus numerical rating scale

7of 10

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

18of 30

Disease assessmentCase Nº 068

Disease assessment

On the skin

Erythema

Red / pink
Violaceous

Thickness

Papulation
Follicular
Site

Lichenification

Nodules
Furrowing

Excoriation

Bleeding

Disease assessmentCase Nº 068

Disease assessment

On the skin, continued

Pigmentary changes

Post-inflammatory hyperpigmentation

Disease assessmentCase Nº 068

Disease assessment

How it shaped care

Impact on diagnosis

Severe AD

Impact on treatment selection

Started with conventional treatment.

Treatment selectionCase Nº 068

Treatment selection

The plan

Continue to strive for disease control.

Treatment goals

Patient returned in December still with significant eczema. He took medication, but was concerned about side effects. He applied creams intermittently and did not receive phototherapy due to schedule.

What drove the choice

Initial treatment did not yield success -- hence, patient was switched to dupilumab,

Safety concerns

Patient was concerned about cyclosporin at this time and wanted safer treatment. Hence, Dupilumab was applied for.

Treatment selectionCase Nº 068

Treatment selection

The plan, continued

Target scores

EASI: 39; from 38
BSA: 58%; from 79%
Itch NRS: 7; from 7
IGA: 3; from 4

Follow-upCase Nº 068

Follow-up · visit 1 of 1

Under 6 months on treatment

EASI

Eczema Area and Severity Index

7of 72

−31 vs baseline of 38

BSA

Body surface area

10%of 100%

−69 vs baseline of 79

Itch NRS

Peak pruritus numerical rating scale

0of 10

−7 vs baseline of 7

IGA

Investigator's Global Assessment

1of 4

−3 vs baseline of 4

DLQI

Dermatology Life Quality Index

5of 30

−13 vs baseline of 18

Follow-upCase Nº 068

Follow-up · visit 1 of 1

Visit 1, continued

Lesions at this visit

Erythema: — Improved
Thickness: — Improved
Lichenification: — Improved
Excoriation: — Improved
Pigmentary changes: — Improved
Other: — Patient returned then in June and even though his treatment led to disease improvement, he developed conjunctivitis.

Symptoms & daily life

Pruritus: — Improved
Work impairment: — Improved
Impaired social function: — Improved

Follow-upCase Nº 068

Follow-up · visit 1 of 1

Visit 1, continued

Treatment plan

Treatment modified

Patient not satisfied: — Conjunctivitis was a problem for a patient
Physician not satisfied: — I was happy with treatment response, but decided to pursue Tralokinumab since patient had private insurance and was troubled by conjunctivitis.
Modification made: — Start tralokinumab

OutcomesCase Nº 068

Outcomes

Scores over time

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

A 27-year-old male with severe atopic dermatitis.

EC2Change Case File Nº 068

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