Excimer laser versus clobetasol propionate 0.05% ointment in prurigo form of atopic dermatitis: a randomized controlled trial, a pilot

Background: Recent findings establish the 308 xenon chloride (XeCl) excimer laser (EL) to be a new option in the area of UVB phototherapy. Since the EL enables high radiant exposure of narrow-band (NB) UVB and precise targeting of affected skin, it appears to be a promising treatment for the prurigo form of atopic dermatitis (AD). Objectives: To investigate the efficacy and safety of the excimer laser therapy compared to a high potent topical corticosteroid in patients with the prurigo form of AD. Study design: Prospective randomised within-patient controlled study. Patients and methods: Thirteen patients with a prurigo form of AD were randomized to receive EL on one side and topical clobetasol propionate (CP) 0.05% ointment on the other side. EL treatment was performed twice a week, during a treatment period of 10 weeks. Clinical responses were evaluated using Physician Assessment of Individual Signs, Physician Global Assessment, Patient Global Assessment and photographic documentation. In addition, histopathological changes were evaluated and duration of remission was monitored by a follow-up period of 6 months. Results: Both treatments resulted in a significant improvement of all outcome measures at after 5 and 10 weeks of treatment. However, during follow-up of six months the EL treated side showed more improvement compared to CP treated site. Histopathology demonstrated marked decrease of epidermal thickness and inflammatory infiltrate in the EL treated sites. No significant side-effects occurred. Conclusion: This study suggest that the EL can safely and effectively be used in the treatment of the prurigo form of AD. For the long-term, the EL might be a good alternative to topical corticosteroids and an option in case of therapy resistant patients. Chapter V