CHICAGO Despite bone-chilling temperatures and the risk of frostbite, patients who underwent experimental whole-body cryotherapy for atopic dermatitis said they were willing to do it again.
This Finnish experience with whole-body cryotherapy was just one of three "outside-the-box" treatments for atopic dermatitis to emerge in recent months and was highlighted by Dr. Albert C. Yan, chief of the dermatology section at Children's Hospital of Philadelphia, during an atopic dermatitis symposium at the American Academy of Dermatology Academy 2008 summer meeting.
▸ Whole-body cryotherapy. This therapy has been used to treat rheumatic inflammation and pain since the 1970s. The rationale for the therapy in atopic dermatitis is based on reports that very cold air increases the body's antioxidative capacity and reduces the conduction velocity of peripheral nerves and the nerve ganglia capacity to synthesize acetylcholine, which is considered a neurotransmitter in atopic pruritus, according to Dr. Yan.
Investigators at the Skin and Allergy Hospital in Helsinki applied whole-body cryotherapy to 18 adults with mild to moderate atopic dermatitis three times a week for 4 weeks, followed by an 8-week follow-up period.
Topical anti-inflammatory preparations or systemic antihistamines were not allowed for 1 week before or at any time during the study, and there was a 6-week washout period for systemic therapy and phototherapy.
The Univers Cryo-Combi whole-body cryotherapy device (Oy MJG Univers Ab, Helsinki) consists of two precooling chambers set at −30° C and −60° C, where patients remained for a very short time, and a third chamber that reaches −110° C, where patients remained for 1 to 3 minutes wearing a bathing suit or trunks, with acral parts covered.
The study's primary end point of change in the Scoring of Atopic Dermatitis (SCORAD) index (scale 0103) decreased almost 20% from 38.7 to 31.1 (Arch. Dermatol. 2008;144:8068).
Pruritus, sleep loss, and SCORAD rating tended to improve after the 4 weeks of treatment.
Three patients had treatment-related adverse events, all mild acral frostbite. Sixteen of the 18 patients completed therapy, an average of 11 sessions (range from 9 to 12 sessions).
One patient left the study because of worsening dermatitis, and another left because of work schedule. All patients were willing to undergo further treatment.
The device used in the study is the first to use both liquid nitrogen and compressor technology to produce cold air. This maintains an optimal oxygen level of 22% in the chamber that allows even patients with asthma to undergo the treatment, according to lead author Dr. Taras Klimenko and colleagues, who reported no conflicts of interest.
The study was supported by grants from The Finnish Society of Dermatology and The Finnish Society of Dermatopathology.
▸ Vitamin D supplementation. Supplements of vitamin D helped improve wintertime onset or exacerbation of atopic dermatitis in children aged 213 years who were randomized to oral ergocalciferol 1000 IU in a double-blind, pilot study (Br. J. Dermatol. 2008;159:2457).
The Investigator's Global Assessmentbased on six categories, ranging from clear (1) to very severe (6)improved by one category in four (80%) of five children on vitamin D versus one (17%) of six children on placebo. Similar improvements were seen in Eczema Area and Severity Index scores.
Lead author Dr. Robert Sidbury of Children's Hospital Boston and his associates suggested that the favorable impact of vitamin D on atopic dermatitis is biologically plausible.
The active form of vitamin D, 1,25-dihydroxyvitamin D3, induces expression of antimicrobial peptides that help prevent skin infection and possess immunosuppressive properties in the skin. Recent research also has drawn attention to the connection between vitamin D-mediated activation of toll-like receptors, production of the antimicrobial peptide cathelicidin, and human susceptibility to bacterial infection.
"Thus, vitamin D deficiency could contribute to the hallmark signs of AD: altered barrier function, immune dysregulation, and inadequate bacterial defence," wrote the authors, who reported no conflicts of interest.
The study was supported by a grant from the Massachusetts General Hospital Center for D-receptor Activation Research in Boston.
▸ Rosiglitazone maleate. Used as an add-on therapy at doses of 24 mg twice daily, rosiglitazone (Avandia) was associated with increased control of severe atopic dermatitis in 6 patients nonresponsive to first- and second-line therapies, according to a retrospective review (Arch. Dermatol. 2008;144:848).
The six patients, aged 1675 years, showed decreased extent of the disease, of inflammation, and of number of flares. In addition, rosiglitazone, which is indicated for the treatment of type II diabetes, allowed for gradual reduction or elimination of systemic steroids in the three patients who used them.
Major clinical improvement appeared between weeks 4 and 12, which suggests that some patients may require at least 3 months for a clinical response, according to lead author Ramona Behshad, principal investigator Dr. Kevin Cooper, and senior author Dr. Neil Korman, all of whom are with Case University, Cleveland.