A clinical experiance of cyclosporin A in severe atopic dermatitis of children

초록

Purpose:Severe atopic dermatitis is a condition that can seriously affect the quality of life and it is therefore important to evaluate any new therapeutic agent which may be of benefit to children with severe disease. This study provided clinical experiences with regard to the efficacy and side effect of cyclosporin A treatment in Korean children. Objects and Methods:This study evaluated 5 children (male 3, female 2, mean age 5) who had severe atopic dermatitis resistant to conventional therapy and/or causing the patient significant suffering and disability. The initial dose of cyclosporin A was 2.7-5.2 mg/kg/day and the duration of treatment was 4-6 weeks. The severity and extent of atopic dermatitis were scored, based on the modified criteria of Hanifin and Rajka, at 0, 2, 4 and 6’th weeks and to evaluate the maintenance effect of cyclosporin, at 10’th week. For safety analysis, we also recorded side effects and evaluated regularily blood pressure, BUN, creatinine, AST, ALT and serum cyclosporin A level. Results:This study showed a significant improvement in both of the symptom severity and the extent of atopic dermatitis. The mean pretreatment severity and extent score was 89% and 81% and after 6 weeks’ treatment, 22% and 30%. The overall change of the total clinical score was 47% of decrease. Blood analysis showed no abnormities in kidney and liver function. There had developed hypertrichosis in 2 patients, abdominal pain in 2, and hypertension in 1. Two patients had to stop the drug after 4 weeks of treatment because of the side effects. After stoping the drug, at the 10’th week evaluation, 3 patients showed symptomatic exacervations but 2 patients could maintain their improved state only with conventional treatment. Conclusion:Despite the side effect, cyclosporin A gave a rapid clinical response to severe refractory atopic dermatitis in children. As a new therapeutic agent of atopic dermatitis, more clinical study is needed about cyclosporin A.