Double‐Filtration Plasmapheresis for the Treatment of Patients With Recalcitrant Atopic Dermatitis

Abstract

The management of recalcitrant atopic dermatitis (AD) is a challenging issue for both clinicians and patients. In this study, we evaluate the clinical efficacy and safety of double-filtration plasmapheresis (DFPP) in patients with recalcitrant AD. Eighteen patients with recalcitrant AD whose clinical condition had not been effectively controlled by current standard medical therapies were treated by either a single course of DFPP (N = 9) or with standard medical therapies only (N = 9). Clinical severity of AD was measured at baseline and at 1 and 4 weeks after treatment in patients in the DFPP group and at the corresponding time points in the control group using the standardized clinical severity scoring system for atopic dermatitis (SCORAD). In the nine patients who underwent DFPP, SCORAD values significantly decreased from 80.6 ± 16.7 (mean ± SD) at baseline to 65.9 ± 20.1 at 1 week and 69.8 ± 20.4 at 4 weeks after DFPP treatment (Wilcoxon signed-rank test, P < 0.05). No significant side-effects were observed during DFPP treatment. In the nine patients with recalcitrant AD who were treated with standard medical therapies, there were no significant differences between the SCORAD values at baseline (70.6 ± 13.9), 1 week (68.0 ± 14.4), and 4 weeks (69.8 ± 17.7) (P > 0.05). DFPP resulted in significant clinical improvements in patients with recalcitrant AD. Further studies are needed to evaluate the long-term clinical usefulness of DFPP in the treatment of patients with recalcitrant AD.

Successful treatment of a patient with severe atopic dermatitis and severe asthma by centrifugal therapeutic plasma exchange

“…We believe, contrary to existing literature,13 that centrifugal TPE is more cost-effective and time efficient in comparison to other methods of plasma exchange (double filtration and immunoadsorption). Puppe and Kingdon18 highlight the difficulties using membrane methods of plasmapheresis in that it required the use of additional disposable sets, high doses of heparin and nursing time as well as a longer procedure length.…”

“…Previous studies using plasma exchange have shown improvement in both drug-resistant bronchial asthma and recalcitrant AD 12 13. Our treatment in a severe atopic adult male with TPE has also shown clear immediate but surprisingly sustained benefit both subjectively and objectively.…”

Successful Treatment of Severe Psoriatic Arthritis and Psoriasis with Double Filtration Plasmapheresis

“…In DFPP, a first filter was used to separate plasma from blood (plasma separator) and a second to filter larger molecules from the plasma (plasma fractionator). Disease activity of the patients with autoimmune diseases could be controlled completely following the rapid depletion of specific disease-associated plasma factors [20][21][22][23][24][25][26][27].…”

Critical updates in the 7th edition of the American Society for Apheresis guidelines

“…The study reported significant clinical improvement and no side effects in patients treated with DFPP. The SCORAD values decreased from baseline at1 and 4 weeks after DFPP treatment (80.6 at Week 1 and approximately 69.8 at Week 4, compared to the control group, in which the SCORAD values remained unchanged (70.6 at Week 1 and approximately 69.8 at Week 4) …”

“…DFPP uses two membranes with different pore sizes to remove high‐molecular weight substances from the patient's plasma. A case control study, comparing patients with recalcitrant AD ( n = 18) who were treated with either a single course of DFPP in addition to standard medical therapy ( n = 9) versus standard medical therapy alone ( n = 9), has been reported . The study reported significant clinical improvement and no side effects in patients treated with DFPP.…”