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Severe Adult Atopic Dermatitis: A Delayed Diagnosis and Biologic Response Story in a Rural Setting

Featuring:

AOAlyssa Ortega, PA-C, MSHS

Updated:Oct 22, 2026

Atopic Dermatitis

About this video

For decades, one patient lived with a skin condition he believed he simply had to endure. By the time he reached a dermatology provider, his disease had progressed to near-total erythroderma, complicated by a hospitalization for sepsis. In this compelling case presentation, Alyssa Ortega, PA-C, walks through the diagnostic questions, competing treatment considerations, and practical challenges of caring for a medically complex patient in a rural community. From ruling out potential mimickers to selecting a biologic amid significant comorbidities and barriers to care, the discussion offers a closer look at the decisions that can change the course of severe atopic dermatitis.

QUICK CHECK

A 62-year-old man with erythrodermic atopic dermatitis was recently hospitalized for sepsis. His comorbidities include CKD stage 3B, prior stroke, and atrial fibrillation. Which systemic option is correctly paired with the presenter’s reason for excluding it?A. Methotrexate: history of strokeB. Cyclosporine: chronic kidney diseaseC. JAK inhibitors: slow onset of actionD. Dupilumab: lab monitoring required

QUICK CHECK

In an adult with lifelong rash who presents with erythroderma (BSA >90%) and has never had a biopsy, which step did the presenter take before starting a biologic?A. Started dupilumab empirically, given the childhood onset typical of atopic dermatitisB. Ordered patch testing to rule out allergic contact dermatitisC. Performed a 4-mm punch biopsy with immunohistochemistry and clonality studies to exclude cutaneous T-cell lymphomaD. Deferred biopsy until topical triamcinolone had been tried for 4 weeks

Continuing Education

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In this 45-minute symposium, expert faculty cover the latest updates for JAK inhibitors, including head-to-head efficacy and safety data for JAK inhibitors and biologics, and share clinical pearls for using JAK inhibitors in dermatology practice for atopic dermatitis."I can say that in my clinic, I am reaching for those high bars. You have toput yourself in the position of the patient or imagine that patient is your family member. Would you want mediocre treatment for them or average treatment or moderate treatment? You’d want them to get the best possible treatment. In my practice I’m now counseling patients 'yes we want clear skin. Yes, we want minimal itch. Yes we want your skin pain gone and for you to sleep better.'”- David Cotter, MD, PhDFC25: Charting the Course to Higher Targets With JAK Inhibition in Atopic Dermatitis: An Online ActivityThis activity is supported by an educational grant from AbbVie.

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HowTo’ Treat the Toughest Spots: Tackling Head and Neck Atopic Dermatitis

“Of course we’re always starting with our basics: we’re using our gentle cleansers, our moisturization, our avoidance of known allergens or triggers, and then we're doing our topicals. But it can be very difficult if you have heavy stuff on your face or you’re required to put it on over and over. It can be really tough. So this paves the way really nicely to say it is time to move up, it is time to think about the next level, and typically the next step up is going to be a biologic agent.” - Peter Lio, MDA ‘HowTo’ activity delivers a short burst of engaging and compact content for learners to study at their own convenience. This microlearning activity is intended to provide practical insights from two experts on ‘HowTo’ improve care in head and neck atopic dermatitis in 10 minutes.This activity is supported by an educational grant from LEO Pharma.