Cyclosporin in the treatment of severe atopic dermatitis: a retrospective study

The aims of this study were to determine the clinical profile of patients with atopic dermatitis who were treated with cyclosporin, and to assess the treatment duration, dose and response to cyclosporin therapy.

Casenotes of patients with atopic dermatitis treated with cyclosporin from January 2000 to February 2002 were analysed.

There were 15 patients (9 males and 6 females) (age range, 1 to 58 years). All had severe disease. The mean initiating dose of cyclosporin was 2.8 mg/kg/day and the mean maximum dose was 3.3 mg/kg/day. Average duration of treatment was 6 months. Rapid improvement was seen within the first 2 weeks and maximum benefit was attained at a mean of 10 weeks. At the end of treatment, 73 % of patients had improved from severe to none, mild or moderate disease. Five patients had a flare of eczema during therapy, 3 related to decrease in dose of medication. All patients relapsed within 3 months of cessation of cyclosporin. One patient with borderline hypertension developed worsening of blood pressure, which returned to baseline after cessation of cyclosporin and treatment with atenolol. No patient had sustained rises in serum creatinine.

Cyclosporin is very useful in patients with severe, recalcitrant atopic dermatitis who have failed conventional therapy. It offers rapid relief of an otherwise disabling skin disease, but its effect is not long-lasting and relapses occur in almost all cases if followed up for long enough.