BI27 Treatment of recalcitrant eczema in a patient with B-cell and natural killer cell lymphopenia of unknown cause. (PubMed, Br J Dermatol)
He had tried superpotent topical corticosteroids and oral prednisolone, as well as emollients, none of which had improved his symptoms...Tralokinumab was trialled for 12 weeks, as this has a single therapeutic target (interleukin-13), but unfortunately there was no improvement. Following discussion with the immunologists, he was commenced on upadacitinib as this was felt to have a more targeted immunosuppressive effect above agents such as methotrexate and dupilumab. We await his next follow-up appointment to assess response. This case highlights the complexity of treating an immunocompromised individual with immunosuppressive agents, when the cause of their immunosuppression is unknown.