A 9-year-old Caucasian boy suffering from chronic atopic dermatitis (AD) since the age of 1 year, who had spent a lot of time at a horse-riding centre, visited the clinic in January 2019. He reported worsening pruritus and scabs on his face, trunk, and extremities, along with a diffused skin dryness (Figures 1 and 2) and a very serious itchy plaque on his lower left limb (Figure 3).
The patient had already undergone skin prick tests for respiratory or food allergies and patch tests for contact dermatitis, all of which resulted in negative. The serum level of total immunoglobulin E was within the normal range. He was treated for a long time with both topical steroids (including hydrocortisone butyrate 0.1%, mometasone furoate 0.1%) and inhibitors of calcineurin (tacrolimus and pimecrolimus) with minimal benefit. He was treated with deflazacort oral solution at a dosage of 1 mg/kg/day for 20 days in several cycles. Despite the treatment, his disease often flared up again.
At the time of the first check-up, the patient had visible Dennie-Morgan lines, inflamed, erythematous papules, and crusty plaques scattered over 75% of his face and body, resulting in an eczema area and severity index (EASI) score of 19. He also had a reddish plaque on his left leg, resistant to steroidal and antimicrobial topical treatments. A culture test of skin scraped specimen was done. A suitable antibiotic was chosen based on an antibiogram test which led to improvement of the patient’s condition.
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