ABSTRACT
Introdução: A dermatite atópica (DA) é uma doença inflamatória da pele, multifatorial, crônica e recorrente, caracterizada por lesões eczematosas e prurido intenso. Nos casos graves refratários aos tratamentos tópicos, tem se utilizado imunossupressão sistêmica para o controle da doença, sendo a ciclosporina considerada por muitos como terapia de escolha. Este estudo visa avaliar a incidência e gravidade dos eventos adversos relacionados ao uso de ciclosporina em pacientes com DA grave. Métodos: Estudo retrospectivo observacional com análise de prontuários de pacientes com dermatite atópica grave em uso de ciclosporina atendidos em hospital terciário no período de 3 anos. Resultados: Avaliados 80 pacientes com dermatite atópica grave usando ciclosporina, com média de idade de 25,5 anos e 41 do sexo feminino (51,3%). Foram relatados eventos adversos em 25 pacientes. O tempo médio de uso de ciclosporina no grupo com eventos adversos foi de 29,3 meses. Os eventos de maior gravidade foram alteração da função renal e hipertensão, sendo mais observados nos casos de doença mais refratária, quando o uso de ciclosporina foi muito prolongado, superior a 60 meses. As reações evidenciadas foram: hipertensão arterial 40%, alteração renal 20%, náuseas/vômitos 16%, cefaleia 12%, herpes de repetição 12% e outros 4%. Os eventos adversos normalizaram após suspensão da ciclosporina. Conclusão: Pacientes com dermatite atópica grave que usaram ciclosporina por tempo prolongado tiveram maior frequência de eventos adversos potencialmente graves. Todos os efeitos adversos normalizaram após a suspensão de medicação.
Rationale: Atopic dermatitis (AD) is an inflammatory, multifactorial, chronic, recurrent skin disease characterized by eczematous lesions and intense itching. In severe cases refractory to topical treatments, systemic immunosuppression has been used to control the disease, and cyclosporine is largely considered firstline therapy. This study aims to assess the incidence and severity of adverse events related to the use of cyclosporine in patients with severe AD. Methods: This retrospective observational study analyzed medical records of patients with severe atopic dermatitis using cyclosporine treated at a tertiary hospital over a 3-year period. Results: Eighty patients with severe atopic dermatitis using cyclosporine were evaluated. Their mean age was 25.5 years, and 41 (51.3%) were female. Adverse events were reported in 25 patients. The mean duration of cyclosporine treatment in the group with adverse events was 29.3 months. The most serious events were changes in renal function and hypertension, which were most often observed in cases of more refractory disease, when the use of cyclosporine was very prolonged (over 60 months). The adverse reactions were hypertension (40%), renal changes (20%), nausea/vomiting (16%), headache (12%), recurrent herpes (12%) and others (4%). Adverse events were under control after cyclosporine was discontinued. Conclusion: Patients with severe atopic dermatitis who used cyclosporine for a long time had a higher frequency of potentially serious adverse events. All adverse effects were under control after discontinuation of medication.
Subject(s)
Humans , Cyclosporine , Cyclosporins/adverse effects , Dermatitis, Atopic , Headache , Hypertension , Nausea , Patients , Therapeutics , Retrospective Studies , Immunosuppression Therapy , Drug-Related Side Effects and Adverse ReactionsABSTRACT
La dermatitis atópica (DA) es una enfermedad inflamatoria crónica de la piel, afecta entre el 1 y el 3% de la población adulta. Se presenta el caso de una mujer de 23 años con antecedentes de asma, rinitis alérgica y dermatitis atópica severa (DAS), con mala respuesta previa a múltiples tratamientos sistémicos, que consultó por exacerbación de su dermatitis y por lesiones papulares progresivas, compatibles con moluscos contagiosos. Destacaba una hiper-eosinofilia y niveles de IgE > 20.000. Por la severidad del cuadro y el estado de inmunosupresión asociado a infección viral extensa, se decide inicio de inmunoglobulina intravenosa (IgIV), con buena respuesta del cuadro cutáneo. Las terapias estándares para la DA se centran en el alivio sintomático y su eficacia clínica, es frecuentemente insuficiente. La IgIV es un tratamiento eficaz en algunas condiciones auto-inflamatorias dermatológicas; existen reportes limitados en el tratamiento de la DAS, principalmente en niños. Otros tratamientos utilizados para estos casos son interferón-gamma y el omalizumab; sin embargo, la evidencia actual es insuficiente y se requieren de más estudios, que demuestren su efectividad en el manejo de la DAS.
Background: atopic dermatitis (AD) is a chronic inflammatory skin disease that affects between 1 to 3% of adults. Case: we report a case of a 23-years old woman with history of asthma, allergic rhinitis and severe atopic dermatitis (SAD), with poor previous response to four systemic treatments. She consulted due to exacerbation of her AD and a four month-course of progressive papular lesions, compatible with molluscum contagiosum. Laboratory evaluation showed hypereosinophilia and IgE levels > 20.000. Because of the severity of the clinical condition and taking in consideration the patient´s immunosupression state, intravenous immunoglobulin (IVIg) 0,4 mg/kg/day was started for five days and three cycles, with good response of her cutaneous lesions. Discussion: the standard therapies for AD are mainly focused on symptomatic relief and its clinical efficacy is often insufficient. The treatment with IVIg is effective in some dermatological autoinflammatory diseases and there are few reports in this matter, especially in children. Other treatments available for these cases are interferon-gamma and omalizumab, but the actual evidence is insufficient and it is required more prospective studies to support their use.
ABSTRACT
PURPOSE: We attempted to investigate clinical characteristics of children with severe atopic dermatitis. METHODS: A total of 204 children diagnosed with Atopic dermatitis at the Pediatric Allergy Respiratory Center in Busan St. Mary's Medical Center from June 2006 to June 2008 were enrolled in this study. Cases were divided into 3 groups according to SCORAD index: severe, moderate and mild groups. We collected birth, environment, and allergic family history, and tested serum IgE, total eosinophil count, specific IgE, ECP (Eosinophil Cationic Protein) and the SCORAD index between the 3 groups. RESULTS: Of the 204 patients, 100 (49.02%) were included in the severe group, 51 (25.0%) in the moderate group, and 53 (25.98%) in the mild group. There were no differences in serum total IgE, serum total eosinophil counts and ECP between the severe and moderate groups. Serum total IgE, serum total eosinophil counts and ECP were relatively higher in the severe group than mild group. Food allergen sensitization rate was relatively higher in the infantile severe group than in the childhood severe group, while inhalant allergen sensitization rate was relatively higher in the childhood severe group than in the infantile severe group. There was no correlation between serum total IgE, serum total eosinophil counts, ECP and the number of sensitized allergens relative to SCORAD index in the severe group. CONCLUSION: Serum IgE, total eosinophil count, specific IgE and ECP may be specific indicators of children with severe atopic dermatitis. Further studies are needed to determine a clear distinction between severe and moderate atopic dermatitis patients.
Subject(s)
Child , Humans , Allergens , Dermatitis, Atopic , Eosinophils , Hypersensitivity , Immunoglobulin E , Parturition , Respiratory CenterABSTRACT
PURPOSE: Severe atopic dermatitis is a condition that can seriously affect the quality of life. This study was performed to evaluate the efficacy and side effect of cyclosporin A treatment in children. METHODS: Nine children(male 7, female 2) with severe atopic dermatitis resistant to conventional therapy and/or significant suffering and disability. The initial dose of cyclosporin A was 2.1-5.2 mg/kg/day and the duration of treatment was 4-6 weeks. The severity and extent of atopic dermatitis were evaluated with modified criteria of Hanifin and Rajka, at 0, 2, 4 and 6th week and after cessation of cyclosporin, at 10th week. Total clinical score was calculated as the average of both extent and severity score. RESULTS: There are significant improvement in both of the symptom severity and the extent of atopic dermatitis. The mean severity and extent scores were 92% and 88% before treatment and 28% and 34% after 6 weeks' treatment. The overall change of the total clinical score was 59% of decrease. Two patients had to stop the drug after 4 weeks of treatment because of severe abdominal pain, especially at night. After stopping the drug, at the 10th weeks' evaluation, 3 patients showed symptomatic exacervations but 6 patients 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.