Treatment of severe atopic dermatitis with extracorporeal photopheresis

Abstract

Extracorporeal photopheresis using UVA irradiation of enriched lymphocytes in the presence of 8-methoxypsoralen (8-MOP) as a photoactivatable substrate has been employed for the treatment of several immunologically mediated disorders. We report on the first three patients subjected to extracorporeal photopheresis for severe atopic dermatitis. All patients had a lifelong history of atopic skin inflammation, and their disease had finally become resistant to well-established therapeutic regimes. Extracorporeal photopheresis resulted in a marked clinical improvement in the skin lesions of all patients. The decrease in cutaneous inflammatory activity became evident by the end of the second photopheresis 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. Clinical remission was stable under maintenance therapy with prolonged intervals between photopheresis sessions. Therapeutic efficacy was reflected 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 of circulating lymphocytes remained essentially unchanged. No clinical signs of immunosuppression or other severe adverse events became evident. Collectively, our preliminary results indicate that extracorporeal photopheresis may interfere with the pathomechanisms leading to atopic dermatitis and therefore should be considered as a treatment modality for severe forms of this recalcitrant disorder.

Atopic dermatitis: from the genes to skin lesions

“…Extracorporeal photopheresis may be a successful therapy for some patients, but due to the high costs and possible side-effects of long-term treatment, this therapy should be limited to severe cases (96).…”

Extracorporeal Photopheresis as a Treatment for Patients with Severe, Refractory Atopic Dermatitis

“…Recently, four open clinical trials have suggested that long-term photopheresis therapy may be safe and effective in severe cases of AD [7,8,9,10]. Photopheresis has also been found to improve laboratory correlates of active AD including hyperimmunoglobulinemia E, and elevated levels of ECP, sIL-2R and soluble E-selectin [10].…”

Vergleichsstudie Solebäder plus UVA/B versus UVA/B-Monotherapie bei Patienten mit subakuter atopischer Dermatitis

“…Phototherapeutische Verfahren sind ein wichtiger Bestandteil im Behandlungskonzept der AD. Dabei werden unterschiedliche Therapiemodalitäten wie UVA, UVB [9,10], PUVA [12], UVA-1 [11] und für sehr schwere Fälle die extrakorporale Photophorese [14] eingesetzt (Übersicht in [6]). Nach den guten Erfahrungen einer Kombination von Meerwasserbädern und Sonnenbestrahlung am Toten Meer bei Patienten mit Psoriasis [7] wurde diese Behandlungsform auch bei Patienten mit AD angewendet [5].…”