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Case Nº 033 · Dr. Maxwell Sauder

EC2Change Case FileAtopic dermatitis

033

A 34-year-old female with moderate disease

  • Advanced systemic failure
  • Prior Dupilumab failure

Case byDr. Maxwell Sauder

1 follow-up visit

At a glanceCase Nº 033

At a glance

A 34-year-old female, moderate atopic dermatitis

ScoreBaselineLatest visit
EASI183
BSA31%5%

In this file

1
The patientCase Nº 033

34

The patient

year-old female,
moderate disease

  • Advanced systemic failure

Comorbidities & context

seasonal allergies
2
Treatment historyCase Nº 033

Treatment history

What came before

Treatment at presentation

Tralokinumab + roflumilast cream

Previous topical therapy

Clobetasol, mometasone, betamethasone, Protopic, Elidel

Previous systemic therapy

Dupilumab

Advanced systemics that failed

  • DupilumabAdverse event
3
Disease assessmentCase Nº 033

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

18of 72

BSA

Body surface area

31%of 100%

4
Disease assessmentCase Nº 033

Disease assessment

On the skin

Erythema

  • Red / pink

Site: Scalp Face Neck Upper Extremities Hands/Palms Trunk Genitals Lower Extremities

Thickness

  • Papulation
5
Disease assessmentCase Nº 033

Disease assessment

On the skin, continued

Excoriation

  • Bleeding
6
Disease assessmentCase Nº 033

Disease assessment

How it shaped care

Impact on treatment selection

history of severe facial erythema with dupilumab as well as moderate conjunctivitis

Impact on outcome measure

sleep NRS, IGA 0/1
7
Treatment selectionCase Nº 033

Treatment selection

The plan

discussed with patient JAK vs tralokinumab. Patient was very safety conscious. She is a mother 4 and has a professional career. As such, when discussing boxed warning despite extensive explanation wanted to go with safest treatment.

Treatment goals

Goal is to "not think about skin" aka ~IGA 0-2

What drove the choice

already mentioned
8
Treatment selectionCase Nº 033

Treatment selection

The plan, continued

Safety concerns

Facial erythema + conjunctivitis as well as infection risk

Target scores

IGA
2
9
Follow-upCase Nº 033

Follow-up · visit 1 of 1

12 months or more on treatment

I follow regularly but latest was 17 months after initiation

EASI

Eczema Area and Severity Index

3of 72

−15 vs baseline of 18

BSA

Body surface area

5%of 100%

−26 vs baseline of 31

Lesions at this visit

Erythema
— mild erythema around orbits
10
Follow-upCase Nº 033

Follow-up · visit 1 of 1

Visit 1, continued

Symptoms & daily life

Work impairment
— No longer affecting professional career. Better functioning due to increased sleep. Little to no absenteeism or presenteeism
Impaired social function
— able to participate more in physical activities with kids. No longer worried about sweating flaring AD

Treatment plan

Treatment continued unchanged

  • Patient satisfied
11
OutcomesCase Nº 033

Outcomes

Scores over time

EASI020Baseline: EASI 1818V1: EASI 33BaselineV1BSA040Baseline: BSA 31%31%V1: BSA 5%5%BaselineV1

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

12

A 34-year-old female with moderate atopic dermatitis.

EC2Change Case File Nº 033

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