Monitoring of therapy in atopic dermatitis--observations with the use of high-frequency ultrasonography

Abstract

Background: In reactive and proactive therapy of atopic dermatitis a well established agent is tacrolimus, a member of calcineurin inhibitors' family. The clinical safety and efficacy of this drug were evaluated previously in randomized multicenter trials. However, so far in clinical studies the assessment of its action on the skin has been made only on the basis of different scores and scales. We present the 6-month observations of tacrolimus therapy in atopic dermatitis patients monitored with the use of noninvasive techniques like high-frequency ultrasonography and evaporimetry.

Methods: The study consisted of 39 patients with AD and their mean age was 26.3 ± 12.8 years. The study lasted 6 months and every 4 weeks patient visited the outpatient clinic (totally 7 visits). The evaluation of disease severity within right antecubital fossa was obtained on the basis of Investigator's Global Assessment (IGA) score. During every control visit noninvasive measurements were carried in the form of HF-USG (with determination of subepidermal low echogenic band, SLEB) and evaporimetry.

Results: 39 patients started the study and 22 of them (54.6%) finished it. Out of 39 patients, 31 (79.5%) received at least 4 week long proactive treatment. We observed statistically significant change of IGA, mean SLEB value and TEWL during underwent therapy. There were also statistically significant differences in mean SLEB and TEWL values between lesional and nonlesional measures.

Conclusions: This report shows the usefulness of HF-USG in monitoring tacrolimus therapy in atopic dermatitis. It is worth emphasizing, that this tool is easily reproducible and allows clinicians to visualize pathologic changes of all skin in vivo. As a noninvasive and independent of subjective judgment method, HF-USG should be included in overall evaluation of atopic dermatitis disease severity together with common scores or scales, especially in the era of evidence based medicine.

Keywords: SLEB; TEWL; atopic dermatitis; high-frequency ultrasonography; proactive therapy; skin USG.