Combination of low-dosage cyclosporine and topical pimecrolimus in severe atopic dermatitis with chronic hepatitis B.

Sir, Atopic dermatitis (AD) is associated with genetic and environmental factors, defects in the cutaneous barrier, bacterial and viral skin infections and immunological changes (1). AD influences the quality of life of both the patient and his or her family (2). Topical steroids are the gold standard treatment for AD, but their use is limited by potential adverse effects, including impairment of the function Langerhans’ cells, cutaneous atrophy, telangiectasias and acne. Nonsteroidal immunomodulant drugs, such as calcineurin inhibitors, tacrolimus and pimecrolimus, do not have these side-effects. Pimecrolimus is indicated in both the shortand long-term treatment of AD (3) and can be applied to areas such as the face and neck. Cyclosporin A (CsA) is another calcineurin inhibitor that blocks the activation of T lymphocytes with transcriptional block of the interleukin (IL)-2, IL-4, tumour necrosis factor (TNF)-α and interferon (IFN)-γ cytokine genes. CsA is used in adults and in children with severe AD refractory to topical treatments (4). AD may be associated with hepatitis; in fact, atopic patients have presented an inadequate Th-1 response and impaired function of natural killer (NK) cells, promoting chronic liver infections such as hepatitis B (5). Treatment with CsA has a therapeutic effect both on hepatitis B and hepatitis C as it inhibits viral replication (6). We report here a patient with severe AD and chronic hepatitis B who was treated successfully with combined treatment of low-dose of CsA (100 mg/daily) and local pimecrolimus.