TREATMENT OF SEVERE ATOPIC-DERMATITIS WITH EXTRACORPOREAL PHOTOPHERESIS

Extracorporeal photopheresis using UVA irradiation of enriched lymphoc ytes in the presence of 8-methoxypsoralen (8-MOP) as a photoactivatabl e substrate has been employed for the treatment of several immunologic ally mediated disorders. We report on the first three patients subject ed to extracorporeal photopheresis for severe atopic dermatitis. All p atients had a lifelong history of atopic skin inflammation, and their disease had finally become resistant to well-established therapeutic r egimes. Extracorporeal photopheresis resulted in a marked clinical imp rovement in the skin lesions of all patients. The decrease in cutaneou s inflammatory activity became evident by the end of the second photop heresis cycle. In two patients skin lesions had virtually disappeared after the fifth treatment cycle, while in the third patient a lasting and substantial improvement in pruritus and erythema was achieved. Cli nical remission was stable under maintenance therapy with prolonged in tervals between photopheresis sessions. Therapeutic efficacy was refle cted by a marked reduction in IgE serum levels in all three patients, while serum concentration of IgG, IgM and IgA as well as the profile o f circulating lymphocytes remained essentially unchanged. No clinical signs of immunosuppression or other severe adverse events became evide nt. Collectively, our preliminary results indicate that extracorporeal photopheresis may interfere with the pathomechanisms leading to atopi c dermatitis and therefore should be considered as a treatment modalit y for severe forms of this recalcitrant disorder.