Cyclosporin A improves severe atopic dermatitis in adults and reduces activated CD4+ T lymphocytes

In this study, we report on the efficacity of low and medium dose levels of cyclosporin A in twelve adults suffering from severe atopic dermatitis. The initial dose of 5 mg/kg/d was reduced as soon as a marked clinical improvement was obtained in an effort to find the therapeutic minimal effective dose. After 3 months, the treatment was continued only where there was sufficient day efficacy (improvement > 70%). The therapeutic effect on the skin was assessed by 2 biopsies (Day 0-Day 60 in 2 patients). The results showed a very rapid fall in the clinical severity score after 15 days of treatment in all patients, but wit great variation in the interindividual minimal effective dose. The study of immunological markers showed a decrease of activated circulating T4 cells in relation to clinical improvement and biopsies showed a lowered activated state (HLA-DR) although T4 cells were still expressed in the dermis.