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Severe refractory atopic dermatitis in an adolescent patient successfully treated with ustekinumab.

Agusti-Mejias A, Messeguer F, García R, Febrer I - Ann Dermatol (2013)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain.

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Interestingly, the number of Th17 cells is higher in acute atopic dermatitis (AD) lesions than in chronic ones in a severity-dependent manner... Other studies have shown conflicting results on the correlation between levels of circulating Th17 cells and severity of AD,... The usefulness of ustekinumab in AD has only been described in one previous case report... In March 2011, the patient began treatment with ustekinumab administered in a single dose of 45 mg... She did not receive any adjuvant or symptomatic treatment... She remained asymptomatic without any skin lesions... The management of severe AD is often difficult and requires successive regimens of oral corticosteroids that may cause important side effects in an adolescent patient... It is directed against interleukin 12 and interleukin 23, which are naturally occurring proteins that regulate the immune system... AD and psoriasis are two conditions with profound clinical and pathogenic differences... The binding between ustekinumab and interleukins 12/23 might prevent the upregulation of Th17 cells in AD,... Against this background, we decided to use the ustekinumab, in an off-label manner, to treat an AD patient who had not reached improvement with other systemic treatments... Our patient showed a total control of her disease without any side effect related to ustekinumab... Although controlled clinical trials will be required to establish the effectiveness of ustekinumab in AD, we suggest that ustekinumab might be a useful and safe treatment of refractory AD in young patients.

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Patient lesions in January 2011, erythematous scaly plaques over 80% of her total body surface (SCORing atopic dermatitis [SCORAD]: 23).
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Figure 1: Patient lesions in January 2011, erythematous scaly plaques over 80% of her total body surface (SCORing atopic dermatitis [SCORAD]: 23).

Mentions: The patient came to our clinic in January 2011 for a flare-up of AD. The physical examination revealed eczematous scaly plaques over 80% of her total body surface, with an objective SCORing atopic dermatitis (SCORAD) of 23 (Fig. 1). The histopathologic study of two lesions showed a superficial perivascular lymphohistiocytic infiltrate. The overlying epidermis revealed irregular acanthosis and mild hyperkeratosis with moderate spongiosis (Fig. 2).


Severe refractory atopic dermatitis in an adolescent patient successfully treated with ustekinumab.

Agusti-Mejias A, Messeguer F, García R, Febrer I - Ann Dermatol (2013)

Patient lesions in January 2011, erythematous scaly plaques over 80% of her total body surface (SCORing atopic dermatitis [SCORAD]: 23).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3756206&req=5

Figure 1: Patient lesions in January 2011, erythematous scaly plaques over 80% of her total body surface (SCORing atopic dermatitis [SCORAD]: 23).
Mentions: The patient came to our clinic in January 2011 for a flare-up of AD. The physical examination revealed eczematous scaly plaques over 80% of her total body surface, with an objective SCORing atopic dermatitis (SCORAD) of 23 (Fig. 1). The histopathologic study of two lesions showed a superficial perivascular lymphohistiocytic infiltrate. The overlying epidermis revealed irregular acanthosis and mild hyperkeratosis with moderate spongiosis (Fig. 2).

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Hospital General Universitario de Valencia, Valencia, Spain.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Interestingly, the number of Th17 cells is higher in acute atopic dermatitis (AD) lesions than in chronic ones in a severity-dependent manner... Other studies have shown conflicting results on the correlation between levels of circulating Th17 cells and severity of AD,... The usefulness of ustekinumab in AD has only been described in one previous case report... In March 2011, the patient began treatment with ustekinumab administered in a single dose of 45 mg... She did not receive any adjuvant or symptomatic treatment... She remained asymptomatic without any skin lesions... The management of severe AD is often difficult and requires successive regimens of oral corticosteroids that may cause important side effects in an adolescent patient... It is directed against interleukin 12 and interleukin 23, which are naturally occurring proteins that regulate the immune system... AD and psoriasis are two conditions with profound clinical and pathogenic differences... The binding between ustekinumab and interleukins 12/23 might prevent the upregulation of Th17 cells in AD,... Against this background, we decided to use the ustekinumab, in an off-label manner, to treat an AD patient who had not reached improvement with other systemic treatments... Our patient showed a total control of her disease without any side effect related to ustekinumab... Although controlled clinical trials will be required to establish the effectiveness of ustekinumab in AD, we suggest that ustekinumab might be a useful and safe treatment of refractory AD in young patients.

No MeSH data available.


Related in: MedlinePlus