A randomized controlled evaluator-blinded trial of intravenous immunoglobulin in adults with severe atopic dermatitis.
BACKGROUND
There is a need for alternative therapy in severe adult atopic dermatitis (AD). Intravenous immunoglobulin (IVIG) treatment has been shown to be beneficial in a few open observations, but evidence of effectiveness is still lacking.


OBJECTIVE
To investigate whether treatment with IVIG is effective in adults with severe AD.


METHODS
In a randomized evaluator-blinded trial, 10 patients with severe AD were randomized to immediate or delayed (by 1 month) treatment with IVIG 2 g kg-1. Patients received an 8-h infusion of 1 g kg-1 daily for two consecutive days. They were assessed clinically at days 15, 30, 60 and 90. The primary efficacy criterion was measurement of the severity scoring of AD (SCORAD) index at day 30.


RESULTS
The SCORAD values were not significantly different between the two groups at day 30. Similarly, global evaluation of disease severity by patients did not show any clinically significant change at day 30. In the cohort of 10 patients, the mean percentage decrease in SCORAD as compared with baseline was, respectively, 15%[95% confidence interval (CI) 6-24%] and 22% (95% CI 5-39%) at 30 and 60 days after IVIG infusion.


CONCLUSIONS
IVIG treatment was not associated with clinically significant improvement of AD signs and symptoms in this randomized study. Although this study may have been too small to detect a beneficial effect in a small subset of patients, the results do not support the common use of IVIG in refractory AD.
Department of Dermatology, Saint Louis University Hospital, 1 avenue Claude Vellefaux, 75475 Paris, France.
C
C
Paul
M
M
Lahfa
H
H
Bachelez
S
S
Chevret
L
L
Dubertret
D000328:Adult; D003876:Dermatitis, Atopic / Q000628:therapy*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
D016756:Immunoglobulins, Intravenous