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

Abstract

Introduction: Atopic dermatitis (AD) is a complex disease with a variety of possible treatment regimens. The study objective was to demonstrate that methoxsalen used in conjunction with the Uvar XTS photopheresis system (Therakos, Exton, Pa., USA) is safe and can have a clinical effect on the skin manifestations and the quality of life in patients with severe, refractory AD. Methods: Single-arm, open-label treatment using the Uvar XTS photopheresis system. Seven patients (4 male and 3 female, median age: 47 years) with severe (SCORAD >45) AD of at least 12 months duration who in the preceding 12 months had been refractory to all 3 of the first-line therapies for AD, i.e. topical steroids, topical calcineurin inhibitors and one form of phototherapy (UVA, UVB or PUVA), or to one of the second-line therapies like systemic steroids or cyclosporine were included in the study. Treatment consisted of two extracorporeal photopheresis treatments (ExP) on successive days every 2 weeks for a minimum of 12 weeks to a maximum of 20 weeks. Quality of life assessment was performed with the SF-36 Health Survey and the Functional Assessment of Chronic Illness Therapy FACT-G Survey. Clinical improvement was documented with SCORAD assessment. Results: ExP led to a significant decrease in the SCORAD score from 77.7 after 10 cycles to 55.6. Patients reported that they had begun to notice improvement of their skin conditions after 5 cycles of photopheresis. The FACT-G score showed significant improvement from 64.8 to 72.9 (p < 0.05) and the SF-36 Health Survey showed significant improvement in the emotional well-being subscores (p < 0.05). Conclusions: ExP can have a significant therapeutic effect on the skin and quality of life improvement in a selected group of patients with severe AD who are refractory to conventional forms of therapy. However, larger studies are needed to further evaluate its therapeutic potential.

Extracorporeal Photochemotherapy as a Challenging Treatment for Cutaneous T-Cell Lymphoma, Acute and Chronic Graft-versus-Host Disease, Organ Rejection and T-Lymphocyte-Mediated Autoimmune Diseases

“…Similar findings regarding ECP treatment have been published in epidermolysis bullosa [51], chronic erosive lichen planus [52] and atopic dermatitis [53]. Unfortunately, the authors only reported on single-center, small non-randomized patients series.…”

Extracorporeal photopheresis: Past, present, and future

“…72 Furthermore, improvement in the Scoring of Atopic Dermatitis score with ECP has been found to be associated with improvements in some measures of patient quality of life. 73 Larger, comparative studies are now required to evaluate further the therapeutic potential of ECP in this indication.…”

Furanocoumarins

“…Atopic dermatitis is an immune-mediated, relapsing skin disorder for which treatment options include a variety of emollients, corticosteroids, immunomodulators, and phototherapy [143]. Atopic dermatitis patients who failed to respond to standard first-and/or second-line therapies showed substantial skin responses to ECP treatment within 6-10 cycles, indicating that photopheresis may have beneficial therapeutic effect in patients who are refractory to conventional therapy [144]. In addition, lichen planus is a chronic mucocutaneous disease that can develop on the skin, mouth, scalp, genitals, or nails.…”