Severe atopic dermatitis in pediatrics with favorable response to anti-IL4: a clinical case report

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease of multifactorial etiology, characterized by moderate to intense itching and erythematous lesions. An increase in the number of cases has been observed in the last decades, however, the mechanism behind this increase is still not well understood. AD is related to genetic predisposition, environmental factors, pollutants, exposure to allergies, and infections. Cutaneous diseases tend to have a significant psychosocial impact on both the patient and caregivers, as they interfere with social and daily relationships and may cause stigmatization due to the skin lesions. Objectives: The objective of this work was to report a case of severe atopic dermatitis in a patient and the favorable treatment with Anti-IL4. Methods: This study consists of an exploratory research with a qualitative approach for a case report from the Dermatological Clinic NEOPELLE in Catanduva-SP, conducted based on the medical record of a patient with a characteristic picture of severe atopic dermatitis with a favorable response to Anti-IL4 and literature review. The current study was grounded on patient data collection through interviews in a medical office, analysis of records from the allergist and dermatologist, photographic documentation of the clinical evolution of the participant, and literature review. Result: In this work we present the case of LMMN, male, 7 years old, born in Catanduva, presented with skin lesions that did not heal, with itching, mainly in the gluteal region, popliteal fossa, and antecubital fossa since the age of 4. The initial prescription was antiviral treatment with no clinical improvement. Shortly after, topical Mupirocin and Bepantol derm were introduced as a moisturizer. The lesions worsened, and other diagnostic hypotheses were considered, such as viral cutaneous manifestations in children, scabies, impetigo, and neoplasia. The impact extended to close family members who required psychological support, along with the patient. Follow-up with an allergist began in 2017. Four years later, an IgE test was requested, confirming the diagnosis of atopic dermatitis. Immunotherapy treatment with Dupilumab was initiated, and the response was extremely positive, with significant improvement in the condition and nearly complete regression of the lesions. Conclusion: Early introduction of targeted therapy is essential as it can alter the natural progression of the disease, along with the support of a multidisciplinary team. The case in question, along with the raised publications, brings forth the discussion of atopic dermatitis therapy and demonstrates that the use of anti IL-4 drugs is capable of achieving satisfactory results, with symptom improvement and benefits to the quality of life for pediatric patients.