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Case Nº 044 · Dr. Perla Lansang

EC2Change Case FileAtopic dermatitis

044

A 66-year-old male with severe disease

  • Advanced systemic failure
  • Special sites: hands
  • Prior Dupilumab failure

Case byDr. Perla Lansang

1 follow-up visit

At a glanceCase Nº 044

At a glance

A 66-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI20—
BSA30%2%
Itch NRS10—

In this file

1
The patientCase Nº 044

66

The patient

year-old male,
severe disease

  • Advanced systemic failure

Special sites involved: Hands

Previous diagnoses

atopic dermatitis

Comorbidities & context

Tatrealogy of Fallot - on amiodarone and Coumadin
2
Treatment historyCase Nº 044

Treatment history

What came before

Treatment at presentation

mometasone PRN

Previous systemic therapy

Discontinued dupilumab, switched to tralokinumab

Advanced systemics that failed

  • DupilumabAdverse event
3
Disease assessmentCase Nº 044

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

20of 72

BSA

Body surface area

30%of 100%

Itch NRS

Peak pruritus numerical rating scale

10of 10

4
Disease assessmentCase Nº 044

Disease assessment

On the skin

Erythema

    Lichenification

      Excoriation

        5
        Disease assessmentCase Nº 044

        Disease assessment

        How it shaped care

        Impact on treatment selection

        Drug interactions with JAK inhibitors Risk of clotting
        6
        Treatment selectionCase Nº 044

        Treatment selection

        The plan

        6 months after stopping dupilumab, his hands, trunk and back started to flare Started tralokinumab (Oct 2023)

        Treatment goals

        Skin clearance and itch reduction

        What drove the choice

        Discontinuation of dupilumab (March 2023) Px decided to wait and see if he would flare

        Safety concerns

        Conjunctivitis and facial dermatitis with dupilumab
        7
        Follow-upCase Nº 044

        Follow-up · visit 1 of 1

        6 to 12 months on treatment

        8 months

        BSA

        Body surface area

        2%of 100%

        −28 vs baseline of 30

        Lesions at this visit

        Erythema
        Lichenification
        8
        Follow-upCase Nº 044

        Follow-up · visit 1 of 1

        Visit 1, continued

        Treatment plan

        Treatment continued unchanged

        • Patient satisfied
        • Physician satisfied
        9
        OutcomesCase Nº 044

        Outcomes

        Scores over time

        BSA030Baseline: BSA 30%30%V1: BSA 2%2%BaselineV1

        V = follow-up visit. Each scale starts at zero.

        10

        A 66-year-old male with severe atopic dermatitis.

        EC2Change Case File Nº 044

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