A 10-year-old boy presents to pediatric dermatology with an acute flare of treatment-resistant atopic dermatitis (AD). He has had recurring flares of AD since his first eczema outbreak at the age of 3 months. Generally, his AD is fairly well managed with rehydration with baths and emollients, with crisaborole ointment used during flares. Three months ago, he presented with an acute flare and was prescribed topical corticosteroids to use on the severely affected areas. He has a family history of eczema and allergy. He does not have asthma or rhinitis. No food allergies have been identified.

Physical exam reveals generalized dry skin which he reports is intensely pruritic and interferes with his sleep. There are large areas of erythematous skin on his neck, face, trunk, and arms, with patches of extensive excoriation accompanied by serous exudate and crusting, with lichenification on the wrists, inner elbow, and on the back of his ankles. There is also keratosis pilaris evident on the backs of his arms.