Joshua Zeichner, MD, reviews the case of a 12-year-old girl with atopic dermatitis.
Joshua Zeichner, MD: Here we have a 12-year-old female patient who presented to her dermatologist with dry, itchy patches on her arms and legs. She admitted to suffering from frequent disturbed sleep, which caused her to miss school and underperform on exams. She also admitted to wearing long-sleeve shirts in school, even on hot days, to prevent her friends from seeing the scratches on her arms. Since her diagnosis 3 years ago, she stopped playing soccer and going to the pool in the summer and has been diagnosed with mild depression.
In terms of her medical history, she was being treated by her primary care doctor for the past 3 years. At the age of 9, she was very active and went outside, but she’d come home with red and dry skin. Her mom would treat her with emollients and moisturizers, applying them 2 times a day after showering. At the age of 10, her flares became worse, triggering her mom to take her to her primary care physician. She was then prescribed hydrocortisone 2% daily. The hydrocortisone 2% was effective for 6 months, but then lacked efficacy.
Over the next several years, she was put on numerous topical steroids and then was switched to pimecrolimus 1% cream, which brought on multiple adverse effects. She was also prescribed prednisone to take care of the flares when they occurred, but she suffered many unwanted adverse effects from it and felt it caused more harm than good. Her mom admitted to also giving her Benadryl when the itching was bad because she didn’t want to see her child in pain, but she suffered from excessive sedation.
In terms of her past medical history, she suffers from depression. For her social history, she’s a middle school student currently on academic probation because of failing classes. She’s on sertraline 25 mg daily. In terms of other clinical workup, all laboratory values are in normal range.
Transcript edited for clarity