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Monitoring of therapy in atopic dermatitis--observations with the use of high-frequency ultrasonography
A Polańska1, W Silny, D Jenerowicz
1Department of Dermatology and Venereology, University of Medical Sciences, Poznań, Poland.
Background:
In reactive and proactive therapy of atopic dermatitis a well established agent is tacrolimus, a member of calcineurin inhibitors' family. The clinical safety and efficacy of this drug were evaluated previously in randomized multicenter trials. However, so far in clinical studies the assessment of its action on the skin has been made only on the basis of different scores and scales. We present the 6-month observations of tacrolimus therapy in atopic dermatitis patients monitored with the use of noninvasive techniques like high-frequency ultrasonography and evaporimetry.
Methods:
The study consisted of 39 patients with AD and their mean age was 26.3 ± 12.8 years. The study lasted 6 months and every 4 weeks patient visited the outpatient clinic (totally 7 visits). The evaluation of disease severity within right antecubital fossa was obtained on the basis of Investigator's Global Assessment (IGA) score. During every control visit noninvasive measurements were carried in the form of HF-USG (with determination of subepidermal low echogenic band, SLEB) and evaporimetry.
Results:
39 patients started the study and 22 of them (54.6%) finished it. Out of 39 patients, 31 (79.5%) received at least 4 week long proactive treatment. We observed statistically significant change of IGA, mean SLEB value and TEWL during underwent therapy. There were also statistically significant differences in mean SLEB and TEWL values between lesional and nonlesional measures.
Conclusions:
This report shows the usefulness of HF-USG in monitoring tacrolimus therapy in atopic dermatitis. It is worth emphasizing, that this tool is easily reproducible and allows clinicians to visualize pathologic changes of all skin in vivo. As a noninvasive and independent of subjective judgment method, HF-USG should be included in overall evaluation of atopic dermatitis disease severity together with common scores or scales, especially in the era of evidence based medicine.
Insights
Tacrolimus therapy for atopic dermatitis can be effectively monitored using noninvasive high-frequency ultrasonography (HF-USG) and evaporimetry. These methods offer objective insights into skin changes, complementing traditional assessment scales.
Area of Science:
- Dermatology
- Medical Imaging
- Pharmacology
Background:
- Tacrolimus is a calcineurin inhibitor used in atopic dermatitis (AD) therapy.
- Previous studies assessed tacrolimus efficacy using clinical scores.
- Objective skin assessment methods were lacking in prior evaluations.
Purpose of the Study:
- To evaluate tacrolimus therapy in AD patients over 6 months.
- To monitor treatment effects using noninvasive techniques: high-frequency ultrasonography (HF-USG) and evaporimetry.
- To compare objective measurements with clinical scores.
Main Methods:
- 39 AD patients participated in the 6-month study.
- Disease severity was assessed using Investigator's Global Assessment (IGA) score.
- Noninvasive measurements included HF-USG (evaluating subepidermal low echogenic band - SLEB) and TEWL (transepidermal water loss) every 4 weeks.
Main Results:
- Significant improvements were observed in IGA scores, SLEB, and TEWL during tacrolimus therapy.
- Statistically significant differences in SLEB and TEWL were noted between lesional and nonlesional skin.
- 54.6% of patients completed the 6-month study.
Conclusions:
- High-frequency ultrasonography (HF-USG) is a useful, reproducible tool for monitoring tacrolimus therapy in atopic dermatitis.
- HF-USG allows in vivo visualization of skin pathology, independent of subjective judgment.
- HF-USG should be integrated into AD severity assessment alongside traditional scores for evidence-based medicine.
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