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Case Nº 066 · Dr. Ivan Litvinov

EC2Change Case FileAtopic dermatitis

066

A 13-year-old male with severe disease

  • Skin of colour

Case byDr. Ivan Litvinov

1 follow-up visit
3 photographs

At a glanceCase Nº 066

At a glance

A 13-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI3311
BSA43%13%
IGA41
DLQI21—

In this file

1
The patientCase Nº 066

13

The patient

year-old male,
severe disease

  • Skin of colour

Race / ethnicity

Indigenous

Fitzpatrick skin type

4

Previous diagnoses

GERD, Acne

Comorbidities & context

NOne
2
Treatment historyCase Nº 066

Treatment history

What came before

Treatment at presentation

Started with Betaderm 0.1% by Fam MD and moisturizers. Then started combination of Rinvoq 15 mg PO QD x 30 days together with Dupilumab 600 mg SC and 300 mg SC q 2 weeks. Cerave Itch relief moisturizing cream + Betaderm and elidel.

Previous topical therapy

Betaderm 0.1% not effective
3
Disease assessmentCase Nº 066

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

33of 72

BSA

Body surface area

43%of 100%

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

21of 30

4
Disease assessmentCase Nº 066

Disease assessment

On the skin

Erythema

    Thickness

      Lichenification

        Excoriation

          Pigmentary changes

            5
            Disease assessmentCase Nº 066

            Disease assessment

            How it shaped care

            Impact on diagnosis

            Severe AD impacting school, sports, hunting and other activities

            Impact on treatment selection

            Start with fast acting treatment (e.g., Upadacitinib) and Dupilumab and discontinue upadacitinib while maintaining biologic rx.
            6
            Disease assessmentCase Nº 066

            Baseline photographs

            7
            Disease assessmentCase Nº 066

            Baseline photographs

            8
            Treatment selectionCase Nº 066

            Treatment selection

            The plan

            Rinvoq 15 QD, Dupilumab + Betaderm/Elidel and Cerave Itch relief moisturizing cream.

            Treatment goals

            Resolution of lesions

            What drove the choice

            JAK inhibitor for fast response and biologic treatment for durability of response/maintenance. Pt may require resque therapy in winter months.

            Safety concerns

            JAK inhibitors have SE but if used short term usually minimal risk is expectedin young healthy individuals.
            9
            Treatment selectionCase Nº 066

            Treatment selection

            The plan, continued

            Target scores

            EASI
            0
            from 33
            BSA
            0%
            from 43%
            IGA
            0
            from 4
            10
            Follow-upCase Nº 066

            Follow-up · visit 1 of 1

            Under 6 months on treatment

            2 weeks

            EASI

            Eczema Area and Severity Index

            11of 72

            −22 vs baseline of 33

            BSA

            Body surface area

            13%of 100%

            −30 vs baseline of 43

            IGA

            Investigator's Global Assessment

            1of 4

            −3 vs baseline of 4

            11
            Follow-upCase Nº 066

            Follow-up · visit 1 of 1

            Visit 1, continued

            Lesions at this visit

            Erythema
            — Much decreased
            Thickness
            — Much decreased
            Lichenification
            — Much decreased
            Excoriation
            — Not itchy any more
            Pigmentary changes
            — Some persist

            Symptoms & daily life

            Pruritus
            — Resolved

            Treatment plan

            Treatment continued unchanged

            • Patient satisfied
            • Physician satisfied
            12
            OutcomesCase Nº 066

            Outcomes

            Scores over time

            EASI040Target 0Baseline: EASI 3333V1: EASI 1111BaselineV1BSA050Target 0%Baseline: BSA 43%43%V1: BSA 13%13%BaselineV1IGA04Target 0Baseline: IGA 44V1: IGA 11BaselineV1

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

            13

            A 13-year-old male with severe atopic dermatitis.

            EC2Change Case File Nº 066

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