Effect of low-dose cyclosporin A microemulsion on disease severity, interleukin-6, interleukin-8 and tumor necrosis factor alpha production in severepediatric atopic dermatitis

Background. The release of cytokines [interleukin-6 (IL6), IL-8 and tumor n ecrosis factor-alpha (TNF-alpha)] by skin cells is involved in the pathogen esis of atopic dermatitis (AD). Objective:To evaluate the effect of low-dos e cyclosporin A (CyA) on clinical symptoms and cytokine secretion in severe pediatric AD. Methods: Ten children with severe AD (SCORAD index > 50) wer e treated for 8 weeks with CyA. The initial dose of 2.5 mg/kg/day was titra ted to a maximum of 5 mg/kg/day until a SCORAD reduction of greater than or equal to 35% was achieved ('treatment response'). After stopping CyA all p atients entered a 4-week follow-up period. Cytokine secretion (IL-6, IL-8 a nd TNF-alpha) from patients' PBMC was assessed by ELISA before and after Cy A treatment and was compared with 18 healthy nonatopic controls. Only the d ata of patients, who responded to CyA and did not experience a relapse duri ng the follow-up period, were evaluated for this paper. Results: Seven pati ents responded to CyA without relapse during the follow-up period. The medi an SCORAD index in these patients improved from 71 at baseline to 22 after CyA treatment (p < 0.001). AD patients' PBMC produced more IL-6, IL-8 and T NF-alpha than PBMC of controls. Suppression of IL-6 (p < 0.05) and IL-8 (p < 0.05) production was observed after CyA treatment. TNF-alpha levels were unchanged by CyA in all patients. Conclusions: The reduction in severity of pediatric AD with CyA is associated with decreased production of IL-6 and IL-8, but not TNF-alpha by PBMC. Copyright (C) 2001 S. Karger AG, Basel.