title: Extracorporeal photochemotherapy as systemic monotherapy of severe, refractory atopic dermatitis: results from a prospective trial.
abstract: BACKGROUND
  Previous work has indicated that extracorporeal photochemotherapy (ECP) may be a safe and effective treatment in patients with severe atopic dermatitis.
  
  
  METHODS
  We performed a prospective study to investigate the effect of a defined 20-week ECP protocol in patients with severe, refractory atopic dermatitis. The patient inclusion criteria included (i) disease duration of at least 1 year, (ii) SCORAD > 45, and (iii) resistance to first-line therapy, including topical steroids, topical calcineurin inhibitors, and one form of phototherapy (UVA, UVB, or PUVA) or one second-line therapy, including systemic steroids or cyclosporine. Ten patients (4 women and 6 men; age range 29 to 61 years) were enrolled and treated with two sessions of standard ECP in 2-week intervals for 12 weeks and 4-week intervals thereafter until week 20. The patients' clinical status and response was determined by SCORAD at baseline and every 2 weeks, and quality of life was assessed every 4 weeks using SKINDEX, SF-36, and FACT scores.
  
  
  RESULTS
  There was a statistically significant (p = 0.015) reduction of the mean SCORAD by 10.3 (95% CI, 2.5 to 18.0) from 64.8 at baseline to 54.5 (i.e., 15.9% reduction) at week 20. In a subset of patients (all of female sex), the relative reduction in SCORAD after ECP was more than 25% at week 20. Improvement in quality of life measured by SKINDEX, SF-36, and FACT did not reach statistical significance.
  
  
  CONCLUSIONS
  We detected a small but significant therapeutic effect of ECP in patients with severe, refractory atopic dermatitis.
authors.affiliation: Research Unit for Photodermatology, Department of Dermatology, Medical University of Graz, Graz, Austria. peter.wolf@medunigraz.at
authors.forename: Peter
authors.initials: P
authors.lastname: Wolf
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgas
authors.forename: Nordwig S
authors.initials: NS
authors.lastname: Tomi
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Schempp
authors.forename: Klaus
authors.initials: K
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D003876:Dermatitis, Atopic / Q000378:metabolism / Q000473:pathology / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D017893:Photopheresis; D011188:Potassium / Q000097:blood; D011446:Prospective Studies; D011788:Quality of Life; D013256:Steroids / Q000627:therapeutic use; D014466:Ultraviolet Rays
chemical_list: D013256:Steroids; D016572:Cyclosporine; D000469:Alkaline Phosphatase; D011188:Potassium