The Effect of Montelukast in the Treatment of Atopic Dermatitis through the SCORAD Index / 대한피부과학회지

ABSTRACT

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease, with genetic and environmental background. The pathogenesis is complex, and although the dermatitis fades during childhood in most cases, the course is unpredictable. Leukotrienes are potent proinflammatory mediators derived from arachidonic acid through the 5-lipoxygenase pathway. Leukotrienes are likely to play a role in the inflammation seen in AD. It is therefore of interest to attempt to reduce the activity of AD by the use of leukotriene antagonists. Montelukast (Singulair(R)) has shown promising results in the treatment of both children and adults with AD, and the safety profile of this medicament is excellent. OBJECTIVE: The objective of our study was to evaluate the efficacy of montelukast for severe AD. METHODS: Thirteen patients with moderate to severe AD were treated with montelukast. The dose of montelukast was 10 mg/day for 8 weeks. At enrollment and on each follow-up visit, every patient was assessed by a single observer and objectively scored for disease extent and severity using SCORing Atopic Dermatitis (SCORAD). In 6 of 13 patients, we measured serum cysteinyl leukotriene levels before and after treatment using ELISA and checked serologic marker such as total Ig E at the first visit and eosinophil counts at every follow-up visit. RESULTS: Patients with a median (range) age of 18.2 (7~38) years participated in the study. Their median SCORAD scores before treatment, at first follow-up (mean 4 weeks later), and at second follow-up (mean 8 weeks later) were 52.4, 35.7, and 29.5. All components of SCORAD (extent, intensity, symptoms) of all patients and eosinophil counts (n=6) had decreased significantly except the extent. Serum cysteinyl leukotriene levels (n=6) had decreased, but not significantly. CONCLUSION: According to our study, montelukast is an effective medicament in the treatment of severe AD patients. So we can take a montelukast as an alternated agent instead of steroid and immunosuppressant agents in severe AD.