title: Topical dinitrochlorobenzene therapy in the treatment of refractory atopic dermatitis: systemic immunotherapy.
abstract: BACKGROUND
  Repeated dinitrochlorobenzene (DNCB) application has been proposed as a systemic immunotherapy on the basis of its ability to stimulate T helper 1 (T(H)1) responses, such as those for systemic lupus erythematosus and HIV infection.
  
  
  OBJECTIVE
  We report the effect of topical DNCB therapy in an open trial in patients with refractory atopic dermatitis (AD).
  
  
  METHODS
  Eight patients with refractory AD received weekly application of 0.2% to 1% DNCB to a 2. 5-cm(2) area on the upper arm after sensitization with 5% DNCB; the position was rotated at each application. Disease activity was monitored by pruritus score, percentage of body involvement, clinical severity score, eosinophil counts, serum IgE levels, and serum soluble interleukin 2 receptor levels.
  
  
  RESULTS
  Six of 8 patients (patients 1-6) showed apparent improvement both on clinical scores and laboratory data until 16 weeks after DNCB therapy (week 16). The clinical severity scores of patients 1 to 6 were significantly correlated with eosinophil counts, IgE levels, and serum soluble interleukin 2 receptor levels. One patient did not show clear improvement, and another (patient 8) showed deterioration. DNCB therapy was discontinued at week 12 for patient 8.
  
  
  CONCLUSIONS
  Topical DNCB may systemically stimulate T(H)1 cell responses of patients with AD, resulting in restoration of the T(H)1/T(H)2 imbalance and possible clinical improvement. These results, however, should be interpreted with caution until additional documentation is obtained.
authors.affiliation: Department of Dermatology, Saitama Medical Center, Saitama Medical School, Saitama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshizawa
authors.forename: H
authors.initials: H
authors.lastname: Matsui
authors.forename: S
authors.initials: S
authors.lastname: Izaki
authors.forename: K
authors.initials: K
authors.lastname: Kitamura
authors.forename: H I
authors.initials: HI
authors.lastname: Maibach
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000473:pathology; D004137:Dinitrochlorobenzene / Q000008:administration & dosage* / Q000276:immunology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007509:Irritants / Q000008:administration & dosage* / Q000276:immunology / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D006377:T-Lymphocytes, Helper-Inducer / Q000187:drug effects* / Q000276:immunology
chemical_list: D004137:Dinitrochlorobenzene; D007509:Irritants