A 36-year-old Caucasian male with history of atopic dermatitis associated with marked dyshidrosis of the feet moreso than hands and IgE elevation to 465 kU/L (upper limit of normal 114 kU/L) presented with pruritic, erythematous, crusted plaques on the feet despite ongoing therapy with dupilumab 300 mg every 2 weeks (Figure 5a). The gene discussed is IGHE; the disease is atopic eczema.