Cyclosporine A in atopic dermatitis

Atopic dermatitis is a chronic pruritic dermatosis that requires individualized treatment. Recent studies have shown that low-dose oral treatment with cyclosporine A may be useful in more severe forms. We report our experience with two patients who had severe atopic dermatitis. Both had high IgE concentration and satisfied Hanifin and Rajka's diagnostic criteria for atopic dermatosis. We began oral treatment at a daily dosage of 5 mg/kg divided into two doses. We monitored cyclosporine concentration in whole blood, as well as kidney and liver function. Contraindications for cyclosporine A were excluded. Clinical improvement commenced between the first and third week of treatment and was marked in one case and partial in the other. Improvement did not correlate with a reduction in serum IgE concentration. Side effects were mild (hypertrichosis, slight trembling, and gingival hypertrophy). On discontinuing treatment, clinical manifestations reappeared. We conclude that cyclosporine A may be an effective alternative for some forms of atopic dermatitis resistant to other treatments.