Enteric-coated mycophenolate sodium versus cyclosporin A as long-term treatment in adult patients with severe atopic dermatitis: a randomized controlled trial.

BACKGROUND: Cyclosporin A (CsA) is frequently used in the treatment of severe atopic dermatitis (AD). Enteric-coated mycophenolate sodium (EC-MPS) may be an alternative with equal efficacy and fewer side effects. OBJECTIVE: The aim of this observer-blinded randomized controlled trial was to compare EC-MPS with CsA as long-term treatment in adult patients with severe AD. METHODS: Fifty five patients with AD were treated with CsA (5 mg/kg) in a 6-week run-in period. Thereafter, patients either received CsA (3 mg/kg; n = 26) or EC-MPS (1440 mg; n = 24) during a maintenance phase of 30 weeks and there was a 12-week follow-up period. Disease activity was measured using the objective SCORAD and serum thymus and activation-regulated chemokine (TARC) levels and side effects were registered. RESULTS: During the first 10 weeks the objective SCORAD and serum TARC levels in the EC-MPS study arm were higher in comparison with the CsA study arm. In addition, 7 of the 24 patients treated with EC-MPS required short oral corticosteroid courses. During maintenance phase disease activity was comparable in both study arms. Side effects in both study arms were mild and transient. After study medication withdrawal, disease activity of the patients in the CsA study arm significantly increased compared with the EC-MPS study arm. LIMITATION: The nonblinding of patients and prescriber of rescue medication are limitations. CONCLUSIONS: This study shows that EC-MPS is as effective as CsA as maintenance therapy in patients with AD. However, clinical improvement with EC-MPS is delayed in comparison with CsA. Clinical remission after stopping EC-MPS lasts longer compared with CsA.

Photosensitivity testing in children.

BACKGROUND: Phototesting is an important diagnostic tool to objectify light-related symptoms. Data on phototesting procedures in children are scarce. OBJECTIVE: The aim of this study was to evaluate phototest results in photosensitivity disorders in children. METHODS: The phototest procedures are described. All children phototested in our department between 1995 and 2007 were included in this retrospective study. Children given the diagnosis of polymorphic light eruption (PLE) were selected for follow-up. RESULTS: A total of 92 children (39 boys and 53 girls, age range 4-16 years) were successfully phototested. A photosensitivity disorder was confirmed in 56 children (61%, 24 boys and 32 girls). PLE was diagnosed in 39%, photosensitivity associated with atopic dermatitis in 23%, and erythropoietic protoporphyria in 23%. Other diagnoses were less common. Ten children with PLE were followed up for at least 5 years. Seven reported their photosensitivity had not changed over time, in two cases it had diminished, and in one patient the photosensitivity had disappeared. LIMITATIONS: Retrospective study design is a limitation. CONCLUSION: Phototesting in children is feasible when performed in a case- and child-dependent manner. PLE was the most prevalent diagnosis in our series followed by photosensitivity in atopic dermatitis.

Throwing a light on photosensitivity in atopic dermatitis: a retrospective study.

BACKGROUND: Photosensitivity in atopic dermatitis (AD) is a well known but ill-defined phenomenon. OBJECTIVES: To determine the prevalence of photosensitivity in patients with AD, define its clinical characteristics, and analyze the photo provocation test (phototest) results. METHODS: A retrospective study of patients with AD who were phototested because of suspected photosensitivity at our department during the period 1994-2004. RESULTS: The total number of patients with AD seen in our department between 1994 and 2004 was 3804, of whom 145 patients (45 men and 100 women) were phototested. Photosensitivity was confirmed in 108 (74%) of these 145 patients (33 men and 75 women). The minimal erythema dose (MED) for UVB was decreased in eight of these 108 patients (7%) and the MED for UVA in five patients (5%). Two major clinical reaction patterns were observed: a polymorphic light eruption-type reaction in 51 patients (47%) and an eczematous reaction in 44 patients (41%). Seventy-two of the 108 patients (67%) had a pathologic reaction to UVA and UVB, 18 patients (17%) were only UVB sensitive, and 18 patients (17%) were only UVA sensitive. Photopatch tests were performed in 125 patients (86%). Twenty-nine patients (23%) had a positive photocontact reaction to one or more substances. CONCLUSION: Photosensitivity is found in approximately 3% of patients with AD and the majority are female. Photosensitivity in patients with AD consists of two clinical reaction patterns distinguishable by phototesting. Patients were diagnosed with either AD and co-existing polymorphic light eruption or photosensitive AD.

Assessment of cyclobutane pyrimidine dimers by digital photography in human skin.

UV-mediated DNA damage and repair are important mechanisms in research on UV-induced carcinogenesis. UV-induced DNA-damage and repair can be determined by immunohistochemical staining of photoproduct positive nuclei of keratinocytes in the epidermis. We developed a new method of analysing and quantifying thymine dimer (TT-CPD) positive cells in the epidermis. Normal skin of healthy controls was exposed to UVB ex vivo and in vivo. Skin samples were immunohistochemically stained for TT-CPDs. Digital images of the epidermis were quantified for TT-CPDs both visually and digitally. There was a UVB-dose dependent induction of TT-CPDs present in the ex vivo UVB-irradiated skin samples. The linear measurement range of the digital quantification was increased compared to the manual counting. The average 24-hour repair rate of the initiated TT-CPDs elicited by the UVB irradiation at T=0 of the 8 HCs showed a 34% decrease of TT-CPD photoproducts by the manual counting method and a 51% decrease determined by digital counting. The digital quantification method improves immunohistochemical quantification of DNA photo damage. It is more sensitive in measuring the extent of DNA-damage per nucleus.