Treatment of Erythrodermic Atopic Dermatitis with Cyclosporine

Cyclosporine is an immunosuppressive drug that inhibits calcineurin to suppress T-cell activation. Multiple studies have demonstrated that cyclosporine is highly effective in treating erythrodermic atopic dermatitis and severe atopic dermatitis. Dosing of cyclosporine ranges from 2.5 to 5 mg/kg/day. Despite cyclosporine’s benefits, it has a lengthy side effect profile; the most significant concern is renal impairment. Additionally, cyclosporine requires frequent lab monitoring, and long-term use is not recommended. Patients can be transitioned to another immunosuppressive agent, such as methotrexate, mycophenolate, azathioprine, or dupilumab, for long-term therapy. Abrupt discontinuation of cyclosporine may result in a rapid escalation of symptoms. Therefore, the dose of cyclosporine must be slowly tapered down to prevent symptom flares.