HH Kwon and KH Kim Ann Dermatol Vol. 24, No. 1, 2012 CASE REPORT http://dx.doi.org/10.5021/ad.2012.24.1.66 Intravenous Immunoglobulin Treatment in a Child with Resistant Atopic Dermatitis Hyuck Hoon Kwon, M.D., Kyu Han Kim, M.D., Ph.D. Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea In a subgroup of patients suffering from atopic dermatitis (AD), treatment is quite difficult even after taking oral immunosuppressants. High-dose intravenous immunoglo- bulin (IVIG) treatment has been reported to be beneficial for them in a few uncontrolled trials. Herein we report a case of intractable AD in a 5-year-old girl who had significant clinical improvement after receiving 3 cycles of IVIG treatment (2 g/kg) without notable side effects. Since the first infusion of IVIG, the patient’s skin lesions improved steadily and the improvement persisted until the 8-month follow-up. The eczema area and severity index score decreased remarkably, while immunologic parameters did not cor- relate with clinical improvement. This case suggests that IVIG therapy can be quite effective and safe for children with resistant AD. (Ann Dermatol 24(1) 66∼69, 2012) -Keywords- Atopic dermatitis, Intravenous immunoglobulins INTRODUCTION Atopic dermatitis (AD) is one of the most common derma- tologic diseases, affecting approximately 20% of children living in industrialized countries. Moreover, approxima- tely 70% of cases of AD affect children less than 5 years of Received July 21, 2010, Revised August 10, 2010, Accepted for publication August 10, 2010 Corresponding author: Kyu Han Kim, M.D., Ph.D., Department of Dermatology, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel: 82-2-2072- 3463, Fax: 82-2-747-5130, E-mail: kyuhkim@snu.ac.kr This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 66 Ann Dermatol age1,2. Most cases of AD are effectively treated with topical steroids, topical calcineurin inhibitors and inter- mittent use of immunosuppressive agents, including oral corticosteroids and cyclosporine. However, for recalci- trant AD, continuous use of systemic immunosuppressive agents is used but is limited by the adverse effects, es- pecially for children. For this subgroup of patients, a num- ber of clinical trials based on immunomodulatory drugs have been conducted with limited success3-5, and high- dose intravenous immunoglobulin (IVIG) therapy has been reported to be effective in some recent trials6-12; in particular, children have shown much higher responses than adults6-8, and no serious side effects accompanied the therapy. In the current report, we present the case of a 5-year-old female with treatment-refractory AD who was remarkably improved with IVIG therapy without notable side effects. Her state of remission continued for 8 months without disease recurrence. CASE REPORT A 5-year-old female with a 3-year history of treatment- refractory AD was referred to our Pediatric Dermatology Clinic. She had failed to respond to 2 years of topical steroids and calcineurin inhibitors. Oral steroid treatments as an inpatient and outpatient during the last year were not much help. Recurrent staphylococcal infections and severe pruritus resulted in numerous hospital admissions. She was clinically depressed and needed a psychiatric consultation. She didn’t show any symptoms of allergic rhinitis and asthma. There was also no family history of AD, allergic rhinitis and asthma. Quantitative measure- ment of the extent and severity of the AD was made using an eczema area and severity index (EASI) scoring system, the initial value of which was 30 (Fig. 1A). Laboratory results showed a total IgE of 11,000 kU/L and multiple allergen stimultaneous tests (RIDA Allergy Screening