title: Assessing itch in children with atopic dermatitis treated with tacrolimus: objective versus subjective assessment.
abstract: This study was undertaken to evaluate the clinical efficacy of tacrolimus for itch reduction in children with atopic dermatitis (AD). Seven children (3 boys and 4 girls) with AD were treated with topical tacrolimus for a consecutive 2-wk period after a 1-wk run-in. The clinical severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) scale. Sleep disturbance, as reported by patients, and nocturnal scratching documented by a wrist movement monitor (DigiTrac), were evaluated at baseline and throughout treatment. The median (interquartile range) objective SCORAD scores before and after treatment were 27.2 (24.8-36.7) and 23.9 (22.6-36.5), respectively (P=.248). Overall SCORAD scores before and after treatment were 36.1 (32.8-45.7) and 29.4 (24.8-45.4), respectively (P=.05). Scores on the itch and sleep disturbance components of the SCORAD were reduced from 5.0 (5.0-6.5) and 4.0 (3.5-5.0) to 4.0 (2.0-5.0) and 3.0 (0.5-4.5), respectively. Total SCORAD was reduced in 6 patients (range, 8%-36% reduction) and remained similar in 1 patient. No significant change in the area or intensity component of the SCORAD was detected 14 d after treatment began (P=.48 and P=.115, respectively). Scratching activity, as documented by the DigiTrac movement recorder, was reduced from 115.0 g/min (64.8-215.5) to 71.5 g/min (51.0-118.0) (P=.028) after 2 wk of treatment. Daily symptom scores (n=6 pairs) for sleep disturbance reported separately each day by patients and parents correlated strongly with each other (intraclass coefficient, 0.60-0.98). The findings of this study show that tacrolimus is effective in relieving itch in children with AD. Investigators suggest that scratching movements, objectively measured with the use of DigiTrac, provide a reliable indicator of AD severity in children.
authors.affiliation: Department of Pediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. ehon@cuhk.edu.hk
authors.forename: Kam-Lun Ellis
authors.initials: KL
authors.lastname: Hon
authors.forename: Man-Ching Adrian
authors.initials: MC
authors.lastname: Lam
authors.forename: Ting-Fan
authors.initials: TF
authors.lastname: Leung
authors.forename: Chung-Mo
authors.initials: CM
authors.lastname: Chow
authors.forename: Eric
authors.initials: E
authors.lastname: Wong
authors.forename: Alexander K C
authors.initials: AK
authors.lastname: Leung
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D011537:Pruritus / Q000188:drug therapy* / Q000503:physiopathology; D012107:Research Design; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus