Skin and Systemic Inflammation in Adults with Atopic Dermatitis Before and after Whole-Body Topical Betamethasone 17-Valerate 0.1% or Tacrolimus 0.1% Treatment: A Randomized Controlled Study

BackgroundAtopic dermatitis (AD) is mainly driven by type 2 inflammation and often treated with topical agents. Studies comparing differences in biomarkers between these treatments are lacking.ObjectivesThe aim of this study was to evaluate the effects of topical betamethasone 17-valerate 0.1% and tacrolimus 0.1% ointment on skin barrier function and inflammatory biomarkers in skin and blood in adults with AD.MethodsIn this randomized parallel-group double-blind double-dummy active-comparator study design, 36 adults with AD were treated with either whole-body topical corticosteroid (betamethasone ointment 0.1% plus placebo once daily, n = 18) or calcineurin inhibitor (tacrolimus ointment 0.1% twice daily, n = 18). At baseline, after 2 weeks of daily treatment and after further 4 weeks of twice-weekly maintenance treatment, we evaluated AD severity, levels of natural moisturizing factor (NMF) and cytokines in the skin and blood and characterized circulating T cells.ResultsMean AD severity at baseline corresponded to moderate disease and decreased significantly in both groups. Levels of NMF increased significantly in the tacrolimus group after 2 weeks of treatment (p = 0.002) and tended to increase more than betamethasone at week 6 (p = 0.06). Most skin cytokines decreased with both treatments. However, IL-8, IL-18, IL-22, IP-10, MDC, MMP-9 and TARC were significantly more decreased with betamethasone than tacrolimus after 2 weeks, while after 6 weeks this was only the case for IL-8 and MMP-9. Approximate half of the systemic cytokines decreased significantly with both treatments, but betamethasone decreased MDC significantly more after 2 weeks of treatment. T-cell characterization analyses indicated slight differences in the expression and activation of T cells between groups.ConclusionTopical treatment of AD with betamethasone and tacrolimus ointment effectively reduced disease severity, cutaneous and systemic inflammatory markers. Betamethasone was more effective in decreasing inflammation, but tacrolimus improved skin hydration (NMF levels) more than betamethasone. We evaluated if full-body treatment with topical corticosteroid (betamethasone) and topical calcineurin inhibitor (tacrolimus) ointment in patients with atopic dermatitis decreased disease severity, decreased inflammatory markers of the skin and in the blood and restored natural moisturizing factor (NMF). We included 36 patients with atopic dermatitis and allocated them randomly to either treatment with betamethasone or tacrolimus. Before treatment, after 2 weeks of daily treatment and after further 4 weeks of biweekly treatment, skin and blood samples were extracted for analysis of biomarkers related to atopic dermatitis and NMF. We found that disease severity decreased in all patients. Betamethasone decreased inflammation in the skin more than tacrolimus, but tacrolimus improved NMF, however, not significantly compared to betamethasone. Both treatments reduced inflammation markers in the blood. In conclusion, treating patients with atopic dermatitis with locally applied anti-inflammatory ointments not only reduces inflammation in the skin, but also in the blood. Use of tacrolimus ointment increased NMF in the skin.image