The Clinical Effect of Topical Diphenylcyclopropenone (DPCP) Therapy in the Treatment of Atopic Dermatitis in Children and Adolescents

소아, 청소년 아토피 피부염에서의 DPCP 면역요법의 임상적 치료효과

Bang, Sook-Hyun;Choi, You-Won;Hahm, Jeong-Hee;Whang, Kyu-Kwang
방숙현;최유원;함정희;황규광

  • Published : 20040100

Abstract

Background: Atopic dermatitis is the most common chronic skin disease in childhood. Severe atopic dermatitis may require use of topical or systemic corticosteroids. These treatments are prone to several adverse side effects. This paper highlights the impressive effect of diphenylcyclopropenone(DPCP) sensitization in some cases of childhood and adolescent atopic dermatitis. Objective: The purpose of this study was to examine the effect of DPCP in treating severe atopic dermatitis of children and adolescents. Methods: Twenty eight patients, who had moderate to severe atopic dermatitis, were recruited in the treatment of DPCP weekly for 10 weeks and followed up for another 4 weeks. Severity of atopic dermatitis was measured using SCORAD index. Results: Sixteen of 28 patients had finished the treatment courses. After 10 weeks of therapy with DPCP, the patient's symptoms were improved and the mean SCORAD index was significantly reduced from 48.9${\pm}$17.8 to 18.0${\pm}$9.1 (p<0.01). During the follow-up period, patients could be managed by topical steroid and oral antihistamine and flare-up was not observed. Conclusion: According to our study, DPCP can be an effective, safe and well-tolerated therapy for moderate to severe atopic dermatitis in children and adolescents. We suggest that DPCP may be effective in the treatment of moderate to severe atopic dermatitis of children and adolescents without serious complications.

Keywords

References

  1. Williams HC. Is the prevalence of atopic dermatitis increasing? Clin Exp Dermatol 1992;17:385-91 https://doi.org/10.1111/j.1365-2230.1992.tb00244.x
  2. Brehler R, Hildebrand A, Thomas A. Recent developments in the treatment of atopic eczema. J Am Acad Dermatol 1997;36:983-94 https://doi.org/10.1016/S0190-9622(97)80284-8
  3. 이상욱, 박영민, 김형옥, 김정원, 아토피 피부염 환장에서 Mycophenolate mofetil의 치료효과. 대피지 2002;40:908-13
  4. Van Joost T, Stolz E, Heule F. Efficacy of low dose cyclosporin in severe atopic skin disease. Arch Dermatol 1987;123:166-7 https://doi.org/10.1001/archderm.123.2.166
  5. Zaki I, Emerson R, Allen BR. Trearment of severe atopic dermatitis in childhood with cyclosporin. Br J Dermatol 1996;135:21-4 https://doi.org/10.1111/j.1365-2133.1996.tb00705.x
  6. Bieder T. Topical tacrolimus (FK506): a new milestone in the management of atopic dermatitis. J Allergy Clin lmmunol 1998;102:555-7 https://doi.org/10.1016/S0091-6749(98)70270-2
  7. Fradin MS. Ellis C, Vorhees JJ. Management of patients and side-effect during cyclosporin therapy for cutaneous disorders. J Am Acad Dermatol 1990;23:1265-74 https://doi.org/10.1016/0190-9622(90)70353-J
  8. Valenta R, Maurer D, Steiner R, Seiberler S, Sperr WR, Valent P, et al. lmmnunoglobilin E response to human proteins in atopic patients. J Invest Dermatol 1996;107:203-8 https://doi.org/10.1111/1523-1747.ep12329617
  9. Hanifm JM, Rajka G. Diagnostic features of atopic dermatitis. Acta Derm Venereal(Stockh)(suppl) 1980;92:44-7
  10. Mosmann TR, Cherwinski H, Bond MW, Giedlin MA, Coffman RL. Two types of murine helper T cell clone. J lmmunol 1986;136:2348-57
  11. Mosmann TR, Moore KW. The role of IL-1O in crossregulation of Thl and Th2 responses. Immunol Today 1991;12:A49-53 https://doi.org/10.1016/S0167-5699(05)80015-5
  12. Van der Heijden FL, Wierenga EA, Bos JD, Kapsenberg ML. High frequency of IL-4-producing CD4+ allergen-specific T lymphocytes in atopic dermatitis lesional skin. J Invest Dermatol 1991;97:389-94 https://doi.org/10.1111/1523-1747.ep12480966
  13. Reinhold D, Kukel S, Goeden B, Neumann D, Kreysel HW. Functional characterization of skin-infiltrating lymphocytes in atopic dermatitis. Clin Exp Immunol 1991;86:444-8 https://doi.org/10.1111/j.1365-2249.1991.tb02951.x
  14. Wierenga EA, Snoek M, Jansen HM, Bos 10, Van Lier RAW, Kapsenberg ML. Human atopen-specific types 1 and 2 T helper cell clones. J Immunol 1991;147:2942-9
  15. Jujo K, Renz H, Abe J, Gelfand EW, Leung DYM. Decreased interferon gamma and increased interleukin-4 production in atopic dermatitis and elevated IgE synthesis. J Allergy Clin Immunol 1992;90:323-31 https://doi.org/10.1016/S0091-6749(05)80010-7
  16. Grewe M, Bruijnzeel-Koomen CAFM, Schopf E, Thepen T, Langeveld-Wildschut AG, Ruzick T et al. A role for Thl and Th2 cells in the immunopathogenesis of atopic dermatitis. Immunol Today 1998;19:359-61 https://doi.org/10.1016/S0167-5699(98)01285-7
  17. Patrick D. Does atopic dermatitis result from cytokine dysregulation? J Invest Dermatol 1994;102:741
  18. Jekler J, Larko O. UVB phototherapy of atopic dermatitis. Br J Dermatol 1988;119:697-705 https://doi.org/10.1111/j.1365-2133.1988.tb03490.x
  19. Boguniewicz M, Jaffe HS, Izu A, Sullivan MJ, York D, Geha RS, et al. Recombinant gamma interferon in treatment of patients with atopic dermatitis and elevated IgE levels. Am J Med 1990;88:365-70 https://doi.org/10.1016/0002-9343(90)90490-5
  20. Hanafin JM, Schneider LC, Leung DYM, Ellis CN, Jaffe HS, Izu AE, et al. Recomninant interferon gamma therapy for atopic dermatitis. J Am Acad Dermatol 1993;28:189-97 https://doi.org/10.1016/0190-9622(93)70026-P
  21. Chien CH, Hsieh KH, Interleukin 2 immunotherapy in children. Pediatrics 1990;86:937-43
  22. Mills LB, Mordan LJ, Roth HL, Winger EE, Epstein WL. Treatment of severe atopic dermatitis by topical immune modulation using dinitrochlorobenzene. J Am Acad Dermatol 2000;42:687-9 https://doi.org/10.1016/S0190-9622(00)90190-7
  23. Stricker RB, Elswood BF, Goldberg B, Dumlao C, Elk JV, Henly J et al. Clinical and immunologic evaluation of HIV-infected patients treated with dinitrochlorobenzene. J Am Acad Dermatol 1994;31:462-6 https://doi.org/10.1016/S0190-9622(94)70212-8
  24. Warbrick EV, Dearman RJ, Basketter DA, Gerberick GF, Ryan CA, Kimber I. Analysis of cytokine mRNA expression following repeated exposure of mice to chemical contact and respiratory allergens. J Appl Toxicol 1998;18:205-13 https://doi.org/10.1002/(SICI)1099-1263(199805/06)18:3<205::AID-JAT502>3.0.CO;2-N
  25. Strick RB, Goldberg B, Epstein W L. Immunological changes in patient with systemic lupus erythematosus treated with topical dinitrochlorobenzene. Lancet 1995;345:1505-6 https://doi.org/10.1016/S0140-6736(95)91062-X
  26. Strick RB, Zhu YS, Elswood BF, Dumlao C, Elk JV, Berger TG, et al. Pilot study of topical dinitrochlorobenzene (DNCB) in human immunodeficiency virus infection. Immunol Lett 1993;36:1-6 https://doi.org/10.1016/0165-2478(93)90060-F
  27. Mills LB. Stimulation of T-cellular immunity by cutaneous application of dinitrochlorobenzene. J Am Acad Dermatol 1986;14:1089-90 https://doi.org/10.1016/S0190-9622(86)80189-X
  28. Stricker RB, Goldberg B, Epstein WL. Topical immune modulation (TIM): a novel approach to the immunotherapy of systemic disease. Immunol Lett 1997;59:145-50 https://doi.org/10.1016/S0165-2478(97)00114-4
  29. Snapper CM, Paul WE. Interferon-$\gamma$ and B cell stimulatory factor-1 reciprocally regulate Ig isotype production. Science 1987;236:944-7 https://doi.org/10.1126/science.3107127
  30. Yoko K, Yuriko O. Improvement of lichen nitidus after topical dinitrochlorobenzene application. J Am Acad Dermatol 1998;39:305-8 https://doi.org/10.1016/S0190-9622(98)70377-9
  31. Black HS, Castrow FF, Gerguis J. The mutagenicity of Dinitrochlorobenzene. Arch Dermatol 1983;121:348-9 https://doi.org/10.1001/archderm.121.3.348
  32. Strobel R, Rohrborn G. Mutagenic and cell transforming activities of dinitrochlorobenzene and squaric acid dibutylester. Arch Toxicol 1980;45:307-14 https://doi.org/10.1007/BF00293811
  33. Bock FG, Fjelde A, Fox HW, et al. Tumor promotion of 1-fluoro-2,4-dinitrobenzene, a potent skin sensitizer. Cancer Res 1969;29:179-82
  34. Wilkerson MG, Wilkin JK, Smith RG. Contaminants of dinitrochlorobenzene. J Am Acad Dermatol 1983;9:554-7 https://doi.org/10.1016/S0190-9622(83)70169-6
  35. Weisburger EK, Russfield AB, Weisburger JH, et al. Testing of 21 environmental aromatic amines or derivatives for ling-term toxicity or carcinogenicity. J Environ Pathol Toxicol 1987;2:325-56
  36. Breslow R, Haynie R, Mirra J. Synthesis of diphenylcyclopropenone. J Am Chem Soc 1959;81:247-8
  37. Hausen BM, Stute J. Diphenylcyclopropenone. A strong contact sensitizer. Chem and Industry 1980;17:699-700
  38. Happel R, Hausen BM, Wiesner-Menzed L. Diohencyprone in the treatment of alopecia areata. Acta Derm Venereol 1983;63:49-52
  39. Wilkerson MG, Connor TH, Henkin J, et al. Assessment of diohencyclopropenone for photochemically induced mutagenicity in the Ames assay. J Am Acad Dermatol 1987;4:606-11
  40. Wilkerson MG, Henkin J, Wilkin JK, et al. DPCP: Examination for potential contaminants, mechanism of sensitization and photochemical stability. J Am Acad Dermatol 1984;11:763-75 https://doi.org/10.1016/S0190-9622(84)80450-8
  41. 전덕규,은희철,이유신. DPCP (Diphencyprone)의 원형 탈모증에서의 치료. 대피지 1991;29:407-13
  42. Naylor MF, Neldner KH, Yarbrough GK, Rasio TJ, Iriondo M, Yeary J. Contact immunotherapy of resistant warts. J Am Acad Dermatol 1988;19:679-83 https://doi.org/10.1016/S0190-9622(88)70222-4
  43. Shah KC, Patel RM, Umrigaar DD. Dinitrochlorobenzene treatment of verruca plana. J Dermatol 1991;18:639-42
  44. 이승동,김미연,백승철,허동,변대규. Diphenylcyclopropenone (DPCP) 국소면역요법으로 호전된 광택태선 2예 대피지 2001;39: 1432-4