Severe
atopic dermatitis causes major impairment in the life of both children and their parents. Generally, symptoms can be controlled with
emollients, topical
steroids,
antibiotics, antihistaminic but some patients remain intensely ill and may require treatment with systemic
steroids and so on.
Cyclosporin has been found to be effective in a variety of inflammatory skin disorders since it reduces the number of activated T-cells expressing
interleukin 2 (IL-2) receptors. In order to monitor the safety and clinical efficacy of
therapy and days of remission we performed
Cyclosporin on 3 children with severe
atopic dermatitis, refractory to all traditional
therapies.
Cyclosporin suspension at dosage of 5 mg/kg daily, in 2 doses for 8 weeks has been used.
Cyclosporin blood levels, liver and kidney function, blood pressure and some immunological parameters (eosinophils,
IgE,
IL-2 receptors) were monitored. All patients showed a marked clinical improvement with reduction of
pruritus,
erythema, papules, vesciculation, excoriation, scaly crusts and lichenification. No clinical or haematological side effects were demonstrated. The soluble
IL-2 receptor concentration decreased even after 8 weeks of treatment in all 3 patients, regardless of
IgE levels (case 1: low
IgE level; case 2: very high
IgE level) as in several others T-cell mediated non
IgE-related
skin disease. The authors suggest that courses of 8 weeks seem effective and safe as well as longer time in producing early remission with the advantage of a low cumulative exposure to the drug. The main question is whether a prolonged remission will permain as well as continuous
therapy. This study underscores the potential value of systemic administration of this powerful immuno-suppressive agent in the treatment of many cases of severe
atopic dermatitis working regardless of the
IgE values. Although 3 cases report does not justify any definitive conclusion however it does a contribute to understand the heterogeneity of
atopic dermatitis and it adds information to its current treatment guidelines.