A report describes a case of an 81-year-old man who presented with a long history of generalized pruritic rash. He rendered a history of insulin-dependent type 2 diabetes mellitus (T2DM), hypertension, and renal cancer following a right nephrectomy. Laboratory results from approximately 14 months before the visit revealed a high blood urea nitrogen level, creatinine level of 2.20 mg/dL, and low glomerular filtration rate. 

Physical examination demonstrated numerous pink excoriated papules on the face, neck, trunk, and extremities; and lichenified plaques on both arms and legs. The patient was diagnosed with severe atopic dermatitis with greater than 10% body surface area involvement. His investigators global assessment score was 4/4, indicating severe disease burden. The biopsy results documented spongiotic dermatitis. 

He received a trial of various topical corticosteroids, including hydrocortisone ointment 2.5%, betamethasone valerate ointment 0.01%, fluocinonide ointment 0.05%, and mupirocin ointment without benefit. Also, three subsequent courses of oral steroids did not provide durable relief. At this point, his peak pruritus numerical rating scale (NRS) score remained 7/10, indicating severe pruritus, negatively impacting the patient′s quality of life and sleep.

He then received tacrolimus acetonide ointment 0.1%, betamethasone dipropionate ointment 0.05%, and triamcinolone acetonide ointment 0.1%. Eleven days later, the patient denied any satisfactory response to the topical regimen and desired alternative therapy for the itch and associated poor sleep. His NRS score remained 10/10 this time, indicating very severe pruritus. He thus received Prednisone 20 mg and doxepin 10 mg for symptom management until the intended transition to dupilumab. He then received dupilumab with a loading dose of 600 mg, then 300 mg every other week after that. At 2- and 4-month follow-ups, the patient documented notable relief in symptoms, including improvement in a rash, decrease in NRS score to 3/10, and improvement in sleep and quality of life.

Pousti BT, Valdes-Rodriguez R. Cutis. 2022 December;110(6):E31-E32. doi:10.12788/cutis.0689