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