Library

Case Nº 064 · Dr. Jensen Yeung

EC2Change Case FileAtopic dermatitis

064

A 32-year-old male with severe disease

  • Skin of colour
  • Advanced systemic failure
  • Special sites: hands, head, neck
  • Prior Dupilumab failure

Case byDr. Jensen Yeung

1 follow-up visit
2 photographs

At a glanceCase Nº 064

At a glance

A 32-year-old male, severe atopic dermatitis

ScoreBaselineLatest visit
EASI34—
BSA56%—
Itch NRS9—
IGA4—
DLQI24—

In this file

1
The patientCase Nº 064

32

The patient

year-old male,
severe disease

  • Skin of colour
  • Special-site involvement
  • Advanced systemic failure

Special sites involved: Hands, Head, Neck

Race / ethnicity

Chinese

Fitzpatrick skin type

4

Previous diagnoses

Atopic Dermatitis
2
The patientCase Nº 064

The patient

The patient, continued

Comorbidities & context

Phototherapy (Broadband UVB 3 times a week for 3 months x 4 courses) Dupilumab 300 mg every 2 weeks--excellent initial response after 6 months of use (EASI 90 responder) but developed facial erythema after 15 months of dupilumab reluctance to go on a JAK inhibitor due to black box warnings
3
Treatment historyCase Nº 064

Treatment history

What came before

Treatment at presentation

Tralokinumab 300 mg every 2 weeks Tacrolimus 0.1% ointment twice a day prn

Previous systemic therapy

Methotrexate 25 mg per week for 18 months--lack of response (EASI 30 improvement) Cyclosporine 5 mg/kg daily for 4 months--GI upset and patient's concern of long term safety

Advanced systemics that failed

  • DupilumabAdverse event
4
Disease assessmentCase Nº 064

Disease assessment

Severity at baseline

EASI

Eczema Area and Severity Index

34of 72

BSA

Body surface area

56%of 100%

Itch NRS

Peak pruritus numerical rating scale

9of 10

IGA

Investigator's Global Assessment

4of 4

DLQI

Dermatology Life Quality Index

24of 30

5
Disease assessmentCase Nº 064

Disease assessment

On the skin

Erythema

  • Red / pink

Thickness

  • Papulation

Site: Hands

Lichenification

    Pigmentary changes

    • Post-inflammatory hyperpigmentation
    6
    Disease assessmentCase Nº 064

    Disease assessment

    How it shaped care

    Impact on treatment selection

    Patient's reluctant to use JAK inhibitors
    7
    Disease assessmentCase Nº 064

    Baseline photographs

    Facial erythema with no scaling. No previous facial involvement of AD
    8
    Treatment selectionCase Nº 064

    Treatment selection

    The plan

    Sporonox 200 mg BID and Tacrolimus 0.1% oint BID for 2 weeks with resolution of facial erythema. However, facial erythema recurred after another 6 weeks of dupiliumab and no response to tactolimus

    Treatment goals

    Adequate control of signs and symptoms of AD with resolution of facial erythema

    What drove the choice

    Patient preferred to stay on a biologic for AD
    9
    Treatment selectionCase Nº 064

    Treatment selection

    The plan, continued

    Safety concerns

    Facial Erythema to dupilumab Patient's fear of JAKs due to black box warnings
    10
    Follow-upCase Nº 064

    Follow-up · visit 1 of 1

    Under 6 months on treatment

    Lesions at this visit

    Erythema
    Thickness
    Pigmentary changes

    Treatment plan

    Treatment continued unchanged

    • Patient satisfied
    • Physician satisfied
    11

    A 32-year-old male with severe atopic dermatitis.

    EC2Change Case File Nº 064

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