Case scenario 3 an adult with severe atopic eczema Questions

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What is the role of systemic immunosuppressive therapy?

Immunosuppressive therapy is generally of proven benefit in the short- and intermediate-term (few months) management of atopic dermatitis. Immunomodulatory therapy (platelet activating factor, immunoglobulins, levamisole, etc.), however, is rarely used. We found immunomodulatory therapy to be poorly reported. We decided that the use of less concrete therapies such as anthelmintics and injections of antibodies/antigen complexes should not be considered here. Instead, we have concentrated on commonly used systemic immunosuppressive agents such as photochemotherapy, ciclosporin, azathioprine and systemic steroids. We examined global indices of well-being and also disease-specific indices such as patient-assessed itch. The long-term morbidity associated with such potentially highly toxic treatments is unclear. Here we concentrate on short-term treatments of the crisis-intervention type, this being the most common use of immunosuppressive treatments in dermatology. Much of the information is based on the NHS systematic review of treatments for atopic eczema highlighted in the opening section of this chapter.

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