Targeted Treatment of Children and Adolescents with Severe AD – Case Studies
The results of therapy with dupilumab in children and adolescents with severe forms of atopic dermatitis (AD) are very good even after a short period, not only from a health perspective but also in terms of the social aspect of the disease and the quality of life of patients. This is illustrated by the following two case studies – an 8-year-old girl and a 17-year-old boy – from the Center for Biological Treatment at the Dermatovenerology Clinic of the 2nd Faculty of Medicine, Charles University, and Bulovka University Hospital.
Initially bullied by classmates, then asked about the 'miracle'
The patient (born in 2014) has suffered from severe AD and bronchial asthma since infancy. Other atopic conditions are present in the girl's family; her father is being treated for asthma, and her mother has a mild form of atopic dermatitis and pollinosis. The patient has two sisters (born in 2009 and 2017), who also have been diagnosed with AD, though in milder forms.
Besides the mentioned diagnoses, the girl is otherwise healthy. Allergological testing confirmed significant sensitization to mites, cat and dog fur, peanuts, egg whites, hazelnuts, apples, cashews, and pistachios. She has no drug allergies.
The patient used topical therapy (corticosteroids, emollients, oil baths) and underwent 20 sessions of phototherapy, but none of these treatment modalities led to a long-term effect. Due to exacerbations of AD, which were complicated by bacterial infections, the girl was repeatedly hospitalized at our clinic.
In March last year, due to the severe form of the disease and meeting the criteria for patients from 6 years of age, we started targeted biological treatment with dupilumab at the recommended dosage. At that time, the EASI (Eczema Area and Severity Index) score was 40, and eczema significantly affected her quality of life. The girl was afraid to go to school because her classmates bullied her due to the appearance of her skin.
The first application process was a bit dramatic as the patient was scared of the injection. However, she managed the administration of the drug well and tolerates the medicine without any side effects. The parents prefer injection applications at our facility.
After 24 weeks of treatment, the EASI index dropped to 2 and remained at this level. Asthmatic symptoms also reduced. The girl's quality of life significantly improved practically after the first injection. According to her mother, she now goes to school and sports activities gladly. The children around her immediately asked what miracle had happened, as she no longer had red and peeling skin.
Finally, free from oozing eczema after two years
The patient (born in 2005) has suffered from severe atopic dermatitis since infancy. He was monitored at dermatology in his hometown. In the past, he used topical therapy, which didn't control the disease. He also underwent 40 sessions of balneophototherapy, but its effect was only short-term and temporary.
In his medical history, there are also obstructive bronchitis episodes, which were always treated with inhaled bronchodilator therapy and corticosteroids. Asthma has not been confirmed yet. Severe AD also occurred in the boy's family, affecting his maternal grandfather. The patient has numerous food allergies – to eggs, poultry, fish, nuts, tropical fruits – and histamine intolerance.
In the last two years, the patient reported a significant worsening of eczema, especially related to stress. Eczema symptoms were most severe in the face, ears, and neck area, complicated by recurring bacterial infections. This often made the young man avoid school and sports. His peers made him aware that he was different in some ways. It's not uncommon for patients with severe AD to have individualized study plans or even homeschooling.
Last autumn, the young man was referred to our clinic by his dermatologist and allergist. At that time, the patient's immunoglobulin E concentration was 5000 IU/ml (age-appropriate norm = 40–160 IU/ml), and the EASI score was 22.1. In November 2022, we started targeted biological treatment with dupilumab.
By December 2022, at the first check-up after a month of therapy, there was significant improvement in the skin condition. The young man experienced relief from itching; according to his mother, for the first time in two years, the oozing eczema in the face and ears stopped. The EASI score was 4.9. The next check-up was scheduled for February 2023 when this case study was being prepared.
MUDr. Michaela Nováková
Center for Biological Treatment, Dermatovenerology Clinic, 2nd Faculty of Medicine, Charles University, and Bulovka University Hospital
Read also the interview with the author of the case studies.
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