Supplementary Material for: Use of lebrikizumab in moderate-to-severe atopic dermatitis in challenging clinical scenarios including atypical presentations, comorbidities, and tattooed skin involvement: four case reports

Introduction: Lebrikizumab is a high-affinity IgG4 monoclonal antibody that selectively binds soluble interleukin (IL)-13, approved for the treatment of moderate-to-severe atopic dermatitis (AD). In this case series, we described the experiences achieved with lebrikizumab in four Italian hospitals.
Case presentation: The first case described a patient with moderate-to-severe AD and cheilitis complicated by bacterial impetiginization who previously received topical and systemic therapies, obtaining only a partial benefit; the 12-week treatment with lebrikizumab achieved skin clearance and cheilitis resolution. The second case highlighted the therapeutic value of lebrikizumab in a patient with sub-erythrodermic AD and concomitant cervical intraepithelial neoplasia grade 3. The third case illustrated the use of lebrikizumab in a patient with moderate-to-severe AD and concomitant asthma, confirming lebrikizumab tolerability and safety. The fourth case described the clinical improvement gained with lebrikizumab on eczema on the tattoo in a patient with obesity and dyslipidemia.
Conclusion: In these challenging cases of moderate-to-severe AD where difficult-to-treat areas were involved, or conventional systemic treatments were contraindicated, lebrikizumab was associated with a marked improvement. No adverse events were reported during the observed follow-up. The presence of concomitant asthma or comorbidities, such as obesity and dyslipidemia, did not appear to hinder treatment feasibility.