Concise communications

Leflunomide as a novel treatment option in severe atopic dermatitis

Article first published online: 30 Apr 2004
DOI: 10.1111/j.0007-0963.2003.05846.x

Comment on this article

Summary

Background  Based on the increasing knowledge of T‐cell‐mediated pathogenesis in atopic dermatitis (AD), systemic immunosuppressive drugs are increasingly applied. The chronic, relapsing course of severe AD necessitates a drug, both efficacious and safe in long‐term application. Leflunomide is a pyrimidine de novo synthesis‐inhibiting immunosuppressant exhibiting an extremely long in vivo half life of its active metabolite.

Objectives  To evaluate the efficacy of leflunomide in long‐term treatment of AD.

Methods  As a proof of principle, we treated two patients with severe AD, recalcitrant to different systemic treatment modalities, for 20 months with leflunomide (loading dose 100 mg daily during 3 days; maintenance dose 20 mg daily). At regular visits physical examination, eczema area and severity index (EASI), visual analogue scale (VAS) for itching, and laboratory findings were assessed with according adjustment of the leflunomide dose.

Results  At the initiation of leflunomide therapy, both patients presented with almost erythrodermic AD (patient 1, EASI 40·0, VAS 10; patient 2, EASI 43·0, VAS 8). Partial remission was observed within 4 and 7 weeks, respectively, and maintained over 20 months (patient 1, median EASI 4·2, median VAS 2; patient 2, median EASI 8·4, median VAS 2) except for one episode of exacerbation in each case. In one patient, remission was stable even after cessation of drug dosing. Severe adverse events were not observed.

Conclusions  Leflunomide was efficient in the long‐term treatment of recalcitrant AD. Controlled studies will be necessary to evaluate the subset of severe AD patients benefiting most from this drug.

Read moreRead more (PDF)

Share this article

0

Favourite

Comments

If you want to submit a letter for publication rather than comment on an article please submit through Scholar One: https://mc.manuscriptcentral.com/bjd

There are no comments for this article yet.

Recent Tweets

@BrJDermatol

08 Dec 2019

Are you a young dermatologist interested in joining the BJD as an editorial trainee? We have exciting opportunities for international trainees and trainees based in the UK/ Ireland. Find out more on the @HealthySkin4All website: https://t.co/DThtM6ybJV

@BrJDermatol

08 Dec 2019

An unusual case of mycosis fungoides with cerebral involvement, which achieved a durable complete remission after autologous stem-cell transplantation and interferon alfa-2a maintenance therapy. https://t.co/LCZbpZwDkc #CTCL #interferon https://t.co/UA8uMiBvI5

@BrJDermatol

07 Dec 2019

31M born in Cape Verde presented w/ 3/52 hx of 7cm bosselated & exulcerated plaque w/ rapid growth & bleeding, assoc. w/ wt loss, fatigue & occasional cough. PCR detected Bartonella spp DNA and also tested +ve for HIV. What's your diagnosis? https://t.co/vC2R8lz0zc #medderm #BJD https://t.co/d8f75TZbhn

@BrJDermatol

06 Dec 2019

This video gives some insight into novel disease pathomechanisms for the skin fragility disorder #RDEB (Recessive dystrophic epidermolysis bullosa) and identifies potential strategies to improve the disease course of RDEB #SkinFibrosis: https://t.co/JWtrG5jp8x

@BrJDermatol

06 Dec 2019

RT The British Association of Dermatologists @HealthySkin4All: New @BrJDermatol research investigated the genetic basis of fibrosis in recessive dystrophic epidermolysis bullosa. This finding could lead to possible future treatment. https://t.co/WmYsCGncdW @CharityDEBRA @Wiley_Health https://t.co/wRgfgUk3jT

@BrJDermatol

06 Dec 2019

RT The Dermatology Clinic London @TheDermClinicUK: Does polygenic risk influence associations between sun exposure and #melanoma? A prospective cohort analysis published in @BrJDermatol: https://t.co/bISSmINuER #dermatology #skincancer

Close