Possibilities of Using a Topical Immunomodulator for Exacerbation of Atopic Eczema – Case Study

Personal History

The patient had mild manifestations of atopic eczema since infancy. Local treatment with mild corticosteroids and emollients was effective, and the condition stabilized during preschool and early school years. At the age of 14, the eczema symptoms worsened, likely in relation to the stress from high school entrance exams. Exacerbation is also triggered by physical exertion, which particularly enhances pruritus, and also menstruation.

In the past, she was found to be allergic to dust mites, cat fur, and cow's milk. She does not undergo treatment in allergy clinics, only limiting the consumption of cow's milk. She occasionally takes bisulepin (Dithiaden) for itching but does not take any other long-term medications. There is no family history of atopic eczema. She lives in a smoke-free household and has a dog that stays outside the family house.

Examination and Local Findings

During the examination, the patient had dry skin all over her body, with the most prominent eczema manifestations visible on her face, neck, and upper extremities. There were dry patches with vibrant erythema, pinpoint excoriations, and extensive infiltrated areas including beginning impetiginization. Ragged skin lesions were visible on the neck. Tests showed elevated IgE (2187 IU/ml), eosinophilia (13.9%), and positive specific IgE for dust mites (class 3), cat epithelium (class 6), and dog fur (class 3).

Condition before starting treatment

Therapy

To reduce inflammation in the acute phase and heal excoriations and ragged lesions, local corticosteroids from group III were prescribed in combination with a local antibiotic. The patient was informed about regimen measures and the necessity of regular skin emollient application. After acute symptoms subsided and patches calmed, maintenance therapy with the topical immunomodulator Protopic 0.1% ointment was started, suitable for patients over 16. The ointment was applied to all patches on the face, neck, and upper extremities twice daily for 14 days. After 2 weeks, the frequency was reduced to once daily at night, and after another week, the patient switched to a proactive regime (application of the ointment twice a week).

Evaluation of Therapy

After just the first 2 weeks of therapy, there was a significant improvement. The skin was more supple, eczema patches regressed, and erythema and infiltration were diminishing. Excoriations were healed. The patient tolerates the immunomodulator Protopic very well and is satisfied with the effectiveness of the therapy as seen in the improved skin condition.

Therapeutic result after two weeks

Conclusion

The case study demonstrates that topical immunomodulators can be successfully used in the treatment of recurrent atopic eczema. The immunomodulator Protopic ointment is suitable for long-term eczema control, reduces the risk of side effects associated with frequent application of local corticosteroids, and contributes to a better quality of life for patients with atopic eczema.

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Source: Marušiaková L. Case study: Will I be pretty again for the prom? Children's Dermatology Department, FN Brno.