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Case Nº 048 · Dr. Ryan Lewinson

EC2Change Case FileAtopic dermatitis

048

A 64-year-old female with moderate disease

  • Advanced systemic failure
  • Prior JAK inhibitor failure

Case byDr. Ryan Lewinson

1 follow-up visit

At a glanceCase Nº 048

At a glance

A 64-year-old female, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI20—
IGA3—
DLQI13—

In this file

1
The patientCase Nº 048

64

The patient

year-old female,
moderate disease

  • Advanced systemic failure

Previous diagnoses

N/a

Comorbidities & context

N/a
2
Treatment historyCase Nº 048

Treatment history

What came before

Treatment at presentation

Dupixent, intermittent TCS

Previous topical therapy

TCS and TCI - adjusted by adding systemics and phototherapy

Previous systemic therapy

Discontinued: - Methotrexate - Upadacitinib - Tralokinumab

Advanced systemics that failed

  • JAK inhibitorAdverse event
3
Disease assessmentCase Nº 048

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

20of 72

IGA

Investigator's Global Assessment

3of 4

DLQI

Dermatology Life Quality Index

13of 30

4
Disease assessmentCase Nº 048

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation

Excoriation

    Other: scattered linear crusts

    5
    Disease assessmentCase Nº 048

    Disease assessment

    How it shaped care

    Impact on diagnosis

    Question diagnosis when advanced Tx fails
    Content with improvement vs clearance
    Physician goals
    6
    Treatment selectionCase Nº 048

    Treatment selection

    The plan

    Ultimately, after failing MTX, Rinvoq and Adtralza, we tried Dupixent. It actually was not working very well at all the first 4-5 months, then by month 6-7 things dramatically improved.

    Treatment goals

    Our primary objective has been to resolve itch. Secondary objective has been to reduce intensity and frequency of flares.

    What drove the choice

    Patient had primary focus on safety, due to experience with adverse events with Rinvoq.
    7
    Treatment selectionCase Nº 048

    Treatment selection

    The plan, continued

    Safety concerns

    NO safety or tolerability concerns on current treatment. NO concerns while on Adtralza, just did not see response. D/C rinvoq due to recurrent UTIs and URTIs
    8
    Follow-upCase Nº 048

    Follow-up · visit 1 of 1

    6 to 12 months on treatment

    8 months

    Lesions at this visit

    Erythema
    — resolved
    Thickness
    — resolved
    Excoriation
    — resolved

    Symptoms & daily life

    Pruritus
    — rare

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    • Physician satisfied
    9

    A 64-year-old female with moderate atopic dermatitis.

    EC2Change Case File Nº 048

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