Acta Dermato-Venereologica 98-10CompleteContent | Page 15
SHORT COMMUNICATION
977
Clinical Experience of Overnight Use of a Temperature-controlled Airflow Device in a Teenager with
Severe Atopic Dermatitis
Grigorios THEODOSIOU and Åke SVENSSON
Department of Dermatology and Venereology, Skåne University Hospital, SE-205 02 Malmö, Sweden. E-mail: [email protected]
Accepted Aug 29, 2018; Epub ahead of print Sep 3, 2018
Children and teenagers with severe atopic dermatitis (AD)
refractory to standard treatment often require systemic
treatment with anti-inflammatory and immunosuppres-
sive drugs. The temperature-controlled laminar airflow
(TLA) (Airsonett™) device is a non-pharmaceutical add-
on treatment option for patients with poorly controlled
allergic asthma. The TLA delivers filtered, allergen-free,
particle-free air to the patient’s breathing zone during the
night (Fig. 1). It has been shown to improve quality of
life (QoL) and reduce symptoms and exacerbations of
asthma (1). Aeroallergens have been shown to elicit AD
(2). However, specific allergen immunotherapy, reduc-
tion in house dust mites, and avoidance measures for
treating AD have shown mixed outcomes (3). The effect
of TLA use in patients with AD has not been sufficiently
investigated. We report here a case of a teenager with
severe AD refractory to intensive topical treatment and
phototherapy, which responded to overnight use of a TLA
during a 12-month period.
CASE REPORT
A 14-year old boy with persistent severe AD and allergic rhino-
conjunctivitis, who had been a patient of our department since
early childhood, was prick-tested and found to be sensitized to
pollen and house dust mite. His disease was severely pruritic with
frequent exacerbations and severe impairment of QoL for years
despite therapy escalation. His parents had repeatedly reported that
he would wake up frequently at night, stay awake due to attacks
of itching, and experienced daytime sleepiness.
The patient had been treated previously with various topical
regimens, including emollients, strong glucocorticosteroids and
tacrolimus 0.1%, with partial improvement. He had also been
treated with narrow-band ultraviolet B phototherapy 3 times a
week for 12 weeks, with no effect and, subsequently, with a UVA/
UVB phototherapy regime, 2 times weekly for 14 weeks, which
resulted in minimal improvement in itch, QoL and sleep-quality.
We decided to try the overnight use of a TLA, initially for a
4-month period, as an add-on treatment, instead of proceeding
Fig. 1. Temperature-controlled laminar airflow (TLA) device
function. Arrows indicate the direction in which particles flow (a) without
and (b) with the TLA operating. The red arrows indicate the the upward
airflow during sleep that concentrates the airborne particles and allergens
to the breathing zone of the patient. The blue arrows indicate the cooled
and filtered air that descends towards the breathing zone of the patient
counteracting the allergen- and particle-rich airflow.
direct to systemic treatment, given the fact that the patient and
his family were reluctant to try systemic immunosuppression.
The effect of the treatment was assessed using SCORing Atopic
Dermatitis (SCORAD)-Index, Investigator Global Assessment
(IGA), Dermatology Life Quality Index (DLQI), visual analogue
scale (VAS)-itch, and VAS-sleep. During overnight use of the
TLA the patient was treated with anti-inflammatory mometasone-
furoate 0.1% cream once daily and an emollient containing 5%
urea at least twice daily.
At the first follow-up visit, 4 months later, the patient’s QoL
was significantly improved, he reported a marked improvement
in sleep quality, and agreed to continue with overnight use of
the TLA. No adverse events were reported. The improvement
in SCORAD was parallel to the improvement in QoL and it was
decided to extend the overnight use of the TLA for a 12-month
period. The visible lesions cleared and the anti-inflammatory
topical therapy was tapered down to twice weekly until the next
follow-up visit.
At the subsequent visit, 4 months later, the patient was almost
free of symptoms, with only residual skin lichenification. He was
able to reduce his treatment to moisturizers only. A significant im-
provement was observed in SCORAD, IGA and DLQI. The same
parameters had plateaued at the 12-month assessment (Fig. 2).
Fig. 2. (a) SCORing Atopic Dermatitis (SCORAD). (b) Investigator Global Assessment (IGA). (c) Dermatology Life Quality Index (DLQI). (d) Visual analogue
scale (VAS)-sleep and VAS-itch before, during and after 12-months’ add-on therapy with Airsonett™ (Airsonett AB, Ängelholm Sweden).
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-3020
Acta Derm Venereol 2018; 98: 977–978