The Effect Of Prednisolone Treatment On Histopathological Outcomes In Skin Of Patients With Atopic Dermatitis

Abstract

Hyperproliferation of keratinocytes leading to epidermal thickness contributes to the clinical features of atopic dermatitis. Corticosteroids are a first line treatment rapidly reducing symptoms. We examined the effect of prednisolone on histological outcomes in skin of patients with atopic dermatitis. METHODS: Sixteen patients with moderate-to-severe atopic dermatitis completed a double-blind, placebo-controlled study to evaluate the effect of oral prednisolone on histopathological changes in skin. After a 16-day run-in period (8 days of 0.25 mg/kg prednisone, 8 days withholding all medications) patients were randomized to placebo or prednisolone at 0.75mg/kg for 5 days, 0.5mg/kg for 5 days, tapering to 0.25 mg/kg for 5 days. Pre-and Day 14 post-treatment patients underwent intradermal challenges and 24h later four punch biopsies were collected (saline intradermal challenge, allergen intradermal challenge, lesional skin and unaffected skin). Changes in histopathology scores were compared between placebo and prednisolone using Mann-Whitney t-tests. RESULTS: The epidermis was two times thicker in lesional vs unaffected skin (p50.0275). There was no effect of allergen or saline challenge on epidermal thickness. Compared to placebo, 14 days of prednisolone treatment significantly reduced epidermal thickness in allergen-challenged skin (p50.0499) with trends for effects in unaffected skin (p50.0593) but not saline-challenged (p50.1605) or lesional skin (p50.1304). There was no effect of prednisolone treatment on measurements of spongiosis, lymphocytic infiltration or neutrophilic infiltration. CONCLUSIONS: Epidermal thickening in this small study of patients with atopic dermatitis is somewhat reduced after 14 days of prednisolone treatment, and this improvement not does not appear to be regulated by lymphocyte or neutrophil levels.