Fig. 2. Patient skin scores measured using the EASI score are shown as solid lines. It can be seen that the score decreased steadily during a full course of IVIG theray. EASI: eczema area and severity index, IVIG: intravenous immunoglobulin. System, R-Biopharn, Darmstadt, Germany) were positive for D. farinae (grade 5), Alternaria (grade 4), house dust (grade 3), and cat (grade 3). The percentage of blood eosinophils was 15.2. She was first treated with cyclosporine (5 mg/kg) without significant benefits; the drug was discontinued after 3 months. After stopping cyclosporine treatment, the patient’s state was slightly aggravated for 7 weeks. The EASI score was 32, which was its highest during the whole disease course. Then, IV-GLOBULIN (Greencross, Yongin, Korea) monotherapy was administered (2 g/kg monthly over 5 days) after hospital admission. Although she experienced mild nausea and headaches with every infusion, the skin symptoms subsided as the rate of infusion was decreased and oral antihistamines were administered. After 3 cycles of treatment with IVIG, the skin lesions improved dramatically (Fig. 1B) and the EASI score declined from 32 to 4 (Fig. 2). The total IgE level and blood eosinophil IVIG Monotherapy in Resistant Atopic Dermatitis of a Child Fig. 1. Significant improvement of atopic dermatitis after intravenous immunoglobulin (IVIG) therapy. (A) Before IVIG treatment. (B) Three months follow up after 3 cycles of IVIG treatment (2 g/kg). percentage were 9,000 kU/L and 15.3% each, which did not change significantly during clinical improvement. After 8 months of follow up in the outpatient clinic, the patient’s AD remained in a state of remission; at that time she was taking a mild topical steroid and using an emollient. DISCUSSION IVIG has expanded beyond its traditional role as a treatment for primary immunodeficiencies, and is widely used in treating severe dermatologic diseases. IVIG has been increasingly used for dermatologic indications, in- cluding dermatomyositis, autoimmune bullous disorders, vasculitic syndromes, and toxic epidermal necrosis; the European Union guidelines have recently been suggested13. In addition to the above-mentioned indications, the high value of IVIG therapy in dermatologic diseases that are otherwise recalcitrant to conventional treatment is being consistently reported. Regarding the clinical use of IVIG for AD, double-blind, placebo-controlled studies have not been conducted. One randomized study14 involving 9 adult patients with AD treated with a single cycle of IVIG monotherapy did not show significant clinical improvement. However, in several case reports and uncontrolled trials, the clinical efficacy of IVIG for children, have been consistently re- ported6-12. There have been 4 open trials of immuno- globulin treatment involving children with severe AD. Kimata6 administered IVIG (0.4 g/kg) to 4 AD patients, 2 of whom had underlying Kawasaki disease and the others had idiopathic thrombocytopenic purpura. All of the children improved in 4∼7 days with sustained remission for 6 months. With clinical improvement, the serum IgE level and eosinophil count also decreased. Huang et al.7 reported that 5 children with severe AD and no other underlying diseases received 3 cycles of IVIG (2 g/kg), and Vol. 24, No. 1, 2012 67