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News

Article

The Gray Area: A Challenging Case of AD in an Older Patient

What would you suggest or prescribe for these AD symptoms in a 68-year-old man? Test your knowledge and take a look at new data on AD in older patients.

Mr George Johnson is a 68-year-old retired preschool teacher who presents a persistent pruritic rash, and a history of recurrent cardiovascular events, including a myocardial infarction 2.5 years ago. He reports a history of atopic dermatitis that has been relatively well controlled until recently; the itching has become more irritating, and he reports sleep disturbances as a result.

Atopic eczema on the knee with clear excoriations and lichenification. Image courtesy of DermNet

Atopic eczema on the knee with clear excoriations and lichenification. Image courtesy of DermNet

Physical examination reveals tractable facial erythema and lateral eyebrow shedding (Hertoghe’s sign). Lichenification is evident on extended sides of the elbows and knees. The patient's skin appears generally dry.

In managing Mr Johnson's AD, which of the following would be appropriate?

Patient and caregiver education highlighting proper bathing practices (eg, avoid hot baths, reduce frequency) and regular application of moisturizers.
Low dose of calcineurin inhibitors ointment mixed with an emollient.
First-generation antihistamines before bedtime, with cautious monitoring.
A biologic (eg, dupilumab or tralokinumab).
All of the above
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