Refractory nummular eczema in child successfully treated with NB-UVB and topical delgocitinib

IF 1.1 Q4 ALLERGY
Ichiro Kurokawa MD, Jun-Ichiro Ono MD
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引用次数: 1

Abstract

A 4-year-old girl with refractory nummular eczema with atopic dermatitis (AD) was reported successfully treated with narrowband ultraviolet B (NB-UVB) once a week (400 mJ/cm2) and topical delgocitinib for 8 weeks. The treatment of NB-UVB and topical delgocitinib improved the severe nummular lesions and strong pruritus, resulting in only brown postinflammatory hyperpigmentation without pruritus. The combination of NB-UVB and topical delgocitinib can be an alternative treatment for refractory nummular eczema in children.

A 4-year-old girl presented with a 2-year history of AD. She had impetigo contagiosum throughout her body due to methicillin-resistant Staphylococcus aureus (MRSA) infection. Subsequently, nummular eczema with elevated erythema, erosion, and brown pigmentation occurred over the former impetigo lesions on the shoulders, buttocks (Figure 1A), and thighs with severe pruritus. She was treated with topical steroids, oral antihistamines, and antimicrobials. However, the patient did not respond to these treatments. Thus, NB-UVB therapy (400 mJ/cm2) once a week and topical delgocitinib twice a day were administered. After 8 weeks, the nummular eczema remarkably improved, resulting in flat brown pigmentation (Figure 1B). Laboratory findings showed eosinophilia (22%) and high immunoglobulin (Ig) E levels (853 IU/ml). Radioallergosorbent test (RAST) had a score of 6 (House dust 1 and dust mite). Bacterial culture from nummular eczema was negative.

Topical corticosteroids, antihistamines, and antimicrobials were ineffective in our case. NB-UVB therapy is a tolerant and effective treatment for children with AD.1 NB-UVB inhibits immunological reactions and has anti-inflammatory and anti-bacterial effects. It also recovers skin barrier defects.2 Therefore, NB-UVB therapy is a tolerant and economical treatment for children with AD. Moreover, it inhibits immune reactions, cytotoxic effects, cis-urocanic induction, and decreases Langerhans cells, antigen presentation, NK cell activity, and apoptosis of T cells and keratinocytes.3 However, the side effects of NB-UVB include erythema, reactivation of herpes simplex, and polymorphous light eruption.

Delgocitinib, a Janus kinase (JAK) inhibitor, is useful for treating AD.4 It is available for children with AD with ages more than 2 years old.5 It inhibits IL-4, IL-13, and IL-31,6 resulting in the relief of pruritus.

In our case, the patient did not respond to topical corticosteroids, antihistamines, or oral antimicrobials. We preferred NB-UVB and topical delgocitinib treatments. We speculated that the synergistic effects of NB-UVB and delgocitinib improved the refractory nummular eczema.

In our case, to reduce the risk, we should have tried to use topical delgocitinib alone at first. Additionally, the safety of long-term NB treatment for children has not been established. Therefore, targeted phototherapy was more preferable to use for children to minimize the risk. Moreover, the safety of the combination of NB and topical delgocitinib has not been established in safety for the risk of skin tumor.7 Therefore, the careful observation in our case should be necessary in the future.

In conclusion, NB-UVB and topical delgocitinib are possible alternative treatments for refractory nummular eczema in children. Further studies on such cases must be accumulated in the future.

The authors declare no conflict of interest.

Approval of the research protocol: N/A

Informed Consent: Written informed consent was obtained from the patient's mother.

Registry and the Registration No. of the study/trial: N/A.

Animal Studies: N/A.

Abstract Image

NB-UVB联合德哥西替尼治疗顽固性湿疹患儿成功
本文报道1例4岁女童难治性numular湿疹合并特应性皮炎(AD),采用窄带紫外线B (NB-UVB)治疗,每周1次(400 mJ/cm2),局部应用德戈西替尼治疗8周。NB-UVB和局部delgocitinib治疗改善了严重的numar病变和强烈的瘙痒,仅导致棕色炎症后色素沉着,无瘙痒。NB-UVB联合局部delgocitinib可作为儿童难治性湿疹的替代治疗方法。1例4岁女童,有2年AD病史。由于耐甲氧西林金黄色葡萄球菌(MRSA)感染,她全身感染了传染性脓疱病。随后,在肩部、臀部(图1A)和大腿的原脓疱疮病变处出现了带有红斑、糜烂和棕色色素沉着的numular湿疹,并伴有严重的瘙痒。她接受了局部类固醇、口服抗组胺药和抗菌剂治疗。然而,患者对这些治疗没有反应。因此,每周1次的NB-UVB治疗(400 mJ/cm2)和每天2次的局部delgocitinib。8周后,疣状湿疹明显改善,出现扁平的棕色色素沉着(图1B)。实验室结果显示嗜酸性粒细胞增多(22%)和高免疫球蛋白(Ig) E水平(853 IU/ml)。放射变应原吸附试验(RAST)得分为6分(室内粉尘1分和尘螨)。钱币型湿疹细菌培养阴性。局部皮质类固醇、抗组胺药和抗菌剂在我们的病例中无效。NB-UVB治疗是一种耐受性和有效的治疗儿童AD.1 NB-UVB抑制免疫反应,具有抗炎和抗菌作用。它还能修复皮肤屏障缺陷因此,NB-UVB治疗对于儿童AD是一种耐受性和经济性的治疗方法。此外,它还能抑制免疫反应、细胞毒性作用、顺式尿中毒诱导、降低朗格汉斯细胞、抗原呈递、NK细胞活性以及T细胞和角化细胞的凋亡然而,NB-UVB的副作用包括红斑、单纯疱疹再激活和多形光疹。Delgocitinib是一种Janus激酶(JAK)抑制剂,可用于治疗AD。它可用于年龄大于2岁的AD患儿它抑制IL-4、IL-13和il -31,6,从而缓解瘙痒。在我们的病例中,患者对局部皮质类固醇、抗组胺药或口服抗菌剂没有反应。我们更倾向于NB-UVB和局部delgocitinib治疗。我们推测NB-UVB和德古西替尼的协同作用改善了难治性湿疹。在我们的病例中,为了降低风险,我们一开始应该尝试单独使用局部delgocitinib。此外,儿童长期NB治疗的安全性尚未确定。因此,有针对性的光疗更适合用于儿童,以减少风险。此外,NB与局部delgocitinib联合使用的安全性尚未确定是否存在皮肤肿瘤风险因此,在我们的情况下仔细观察应该是必要的,在未来。综上所述,NB-UVB和局部delgocitinib是治疗难治性湿疹患儿可能的替代治疗方法。今后必须积累对此类案例的进一步研究。作者声明无利益冲突。研究方案的批准:N/知情同意:从患者母亲处获得书面知情同意。注册处及注册编号研究/试验:无。动物研究:无。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.60
自引率
10.00%
发文量
69
审稿时长
12 weeks
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