Clearance May Not be a Realistic Expectation for Patients Treated for Atopic Dermatitis

Journal of Pan-Arab League of Dermatologists
Vol. 20, No. 1, February 2009  Page 79- 88

Clearance May Not be a Realistic Expectation for Patients Treated forAtopic Dermatitis
Al-Otaibi Mohammad F*, Fleischer Alan B** and Feldman Steven R**
Department of Dermatology*, As’ad Al-Hamad Dermatology Center, Kuwait, Bristol-Myers Squibb Center for
Dermatology Research** and Dermatology Department, Wake Forest University School of Medicine,
Winston-Salem, North Carolina

 Abstract

Introduction:Atopic dermatitis is a commonchronic skin disease characterized by severepruritus, typical morphology anddistribution ofthe skin lesions and a personal or family historyof atopy. We have recently demonstrated thatclearance ofatopic dermatitis may not be a realisticexpectation of therapy.

Objective: The purpose of this study is to assesswhethercomplete clearance is expected with thecurrently available treatments for atopic dermatitis.

Methods: Controlled clinical trialsof atopicdermatitis with greater that 10 patients treatedwith the active drug or treatment modality wereidentified from themedical literature, and thosestudies which reported clearance rates werecompared.

Results: The proportion of patients whoexperiencedcomplete clearing of atopic dermatitisvaried with the treatment modality. Representativereported clearance ratesof systemic therapyinclude evening primrose oil 24%, gammainterferon 53%, and cyclosporin (71% to 88%).The physical modality clearance rates were asfollowing: ultraviolet A1 (UVA1) (34% to 50%),topical photochemotherapy (PUVA) (50%to72%), and ultraviolet B (UVB) reported clearancerate 76%. The clearance rates varied bytopical treatment and rangedfrom 35% for halobetasolpropionate cream to 93.6% for mometasonefuroate cream.

Conclusion: The treatments available foratopicdermatitis give physicians the opportunity tocontrol the severity of atopic dermatitis. Severelyaffected patients thatparticipate in trials ofsystemic therapies or physical modalities shouldnot generally expect clearance. More mildly affectedpatients that participate in trials of topicaltherapies are more likely to clear by the endof the trial, but failure rates for allpatientsrange from 6% to 76% because of both thisfailure rate and disease chronicity. The differencesbetween clinical trialdesign limit ourability to make conclusions about relative effectiveness.

Journal of Pan-Arab League of Dermatologists
Vol. 20, No. 1, February 2009  Page 79- 88

Clearance May Not be a Realistic Expectation for Patients Treated forAtopic Dermatitis
Al-Otaibi Mohammad F*, Fleischer Alan B** and Feldman Steven R**
Department of Dermatology*, As’ad Al-Hamad Dermatology Center, Kuwait, Bristol-Myers Squibb Center for
Dermatology Research** and Dermatology Department, Wake Forest University School of Medicine,
Winston-Salem, North Carolina

 Abstract

Introduction:Atopic dermatitis is a commonchronic skin disease characterized by severepruritus, typical morphology anddistribution ofthe skin lesions and a personal or family historyof atopy. We have recently demonstrated thatclearance ofatopic dermatitis may not be a realisticexpectation of therapy.

Objective: The purpose of this study is to assesswhethercomplete clearance is expected with thecurrently available treatments for atopic dermatitis.

Methods: Controlled clinical trialsof atopicdermatitis with greater that 10 patients treatedwith the active drug or treatment modality wereidentified from themedical literature, and thosestudies which reported clearance rates werecompared.

Results: The proportion of patients whoexperiencedcomplete clearing of atopic dermatitisvaried with the treatment modality. Representativereported clearance ratesof systemic therapyinclude evening primrose oil 24%, gammainterferon 53%, and cyclosporin (71% to 88%).The physical modality clearance rates were asfollowing: ultraviolet A1 (UVA1) (34% to 50%),topical photochemotherapy (PUVA) (50%to72%), and ultraviolet B (UVB) reported clearancerate 76%. The clearance rates varied bytopical treatment and rangedfrom 35% for halobetasolpropionate cream to 93.6% for mometasonefuroate cream.

Conclusion: The treatments available foratopicdermatitis give physicians the opportunity tocontrol the severity of atopic dermatitis. Severelyaffected patients thatparticipate in trials ofsystemic therapies or physical modalities shouldnot generally expect clearance. More mildly affectedpatients that participate in trials of topicaltherapies are more likely to clear by the endof the trial, but failure rates for allpatientsrange from 6% to 76% because of both thisfailure rate and disease chronicity. The differencesbetween clinical trialdesign limit ourability to make conclusions about relative effectiveness.