Rituximab as a treatment for severe atopic eczema: failure to improve in three consecutive patients

Biological therapies may provide the breakthrough in treating moderate to severe atopic eczema (AE) that is unresponsive to standard therapy. Rituximab has been shown to benefit some patients in published case series, and so we treated three consecutive patients with severe AE with rituximab. Despite achieving low/absent peripheral blood CD19 +  B-cell numbers following rituximab administration, this was not associated with clinical benefit as there was no major change in pre- and post-treatment Eczema Area and Severity Index (34, 64.4 and 42.2 compared with 33.2, 66 and 56.4, respectively). We would therefore recommend that that there is a compelling need for a formal, double-blind, placebo-controlled study to demonstrate efficacy of rituximab as a treatment of moderate to severe AE.