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Case Nº 019 · Dr. Mohanned Abu-Hilal

EC2Change Case FileAtopic dermatitis

019

A 50-year-old female with severe disease

  • Special sites: hands
  • Prior JAK inhibitor failure

Case byDr. Mohanned Abu-Hilal

2 follow-up visits

At a glanceCase Nº 019

At a glance

A 50-year-old female, severe atopic dermatitis

ScoreBaselineLatest visit
EASI163
BSA15%5%
IGA31

In this file

1
The patientCase Nº 019

50

The patient

year-old female,
severe disease

  • Special-site involvement

Special sites involved: Hands

Previous diagnoses

AD with significant hand involvement RA

Comorbidities & context

Mild RA on MTX 15 mg mostly for RA, and AD
2
Treatment historyCase Nº 019

Treatment history

What came before

Treatment at presentation

mometasone, clobetasol, topical tacrolimus also MTX 15 mg for both mild RA and AD!

Advanced systemics that failed

  • JAK inhibitorAdverse event
3
Disease assessmentCase Nº 019

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

16of 72

BSA

Body surface area

15%of 100%

IGA

Investigator's Global Assessment

3of 4

4
Disease assessmentCase Nº 019

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation

Lichenification

    Excoriation

    • Bleeding

    Site: hands

    5
    Treatment selectionCase Nº 019

    Treatment selection

    The plan

    Rinvoq was prescribed to treat both RA and AD MTX stopped

    Treatment goals

    Improving EASI, itching and clearing hands

    What drove the choice

    The concurrent RA

    Safety concerns

    Initially no concerns.
    6
    Treatment selectionCase Nº 019

    Treatment selection

    The plan, continued

    Target scores

    EASI
    6
    from 16
    BSA
    5%
    from 15%
    IGA
    1
    from 3
    7
    Follow-upCase Nº 019

    Follow-up · visit 1 of 2

    Under 6 months on treatment

    4 months

    EASI

    Eczema Area and Severity Index

    4of 72

    −12 vs baseline of 16

    BSA

    Body surface area

    5%of 100%

    −10 vs baseline of 15

    IGA

    Investigator's Global Assessment

    1of 4

    −2 vs baseline of 3

    Lesions at this visit

    Erythema
    — mild
    Thickness
    — mild
    8
    Follow-upCase Nº 019

    Follow-up · visit 1 of 2

    Visit 1, continued

    Treatment plan

    Treatment modified

    Patient not satisfied
    — patient had cystic acne on jaws
    Physician not satisfied
    — Blood work showed cytopenia mostly lymphopenia
    Modification made
    — switch tot tralokinumab.
    9
    Follow-upCase Nº 019

    Follow-up · visit 2 of 2

    Under 6 months on treatment

    EASI

    Eczema Area and Severity Index

    3of 72

    −13 vs baseline of 16

    IGA

    Investigator's Global Assessment

    1of 4

    −2 vs baseline of 3

    Lesions at this visit

    Erythema
    — mild
    Thickness
    — mild

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    • Physician satisfied
    10
    OutcomesCase Nº 019

    Outcomes

    Scores over time

    EASI020Target 6Baseline: EASI 1616V1: EASI 44V2: EASI 33BaselineV1V2BSA020Target 5%Baseline: BSA 15%15%V1: BSA 5%5%BaselineV1V2IGA04Target 1Baseline: IGA 33V1: IGA 11V2: IGA 11BaselineV1V2

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

    11

    A 50-year-old female with severe atopic dermatitis.

    EC2Change Case File Nº 019

    Contributed by Dr. Mohanned Abu-Hilal. Compiled from the physician’s case-builder submission, in their own words.