INTRODUCTION
Topical corticosteroids (TC) are commonly regarded as a mainstay of AD therapy. However, there exist several problems including topical steroid addiction (TSA) or Red burning skin syndrome.1,2 There are a considerable number of patients with AD who are reluctant to use them because of steroid-phobia.3 Calcineurin inhibitors such as tacrolimus and pimecrolimus seemed to be good alternative medication for those patients. But still there are patients who don’t dare to accept the treatment because calcineurin inhibitors have potential risk of lymphomagenesis even though the result of long-term clinical observation is reported negative.4 On the other hand, recently it has been reported that Burkitt lymphoma was found in a child with AD and 7-year history of topical tacrolimus use.5 Such patients seem to require much more “gentle†and riskless medication.
Recently, topical PPAR alpha ligand application has been reported to improve experimental allergic dermatitis. Several interesting findings are reported about peroxisome proliferator-activated receptor (PPAR) and cutaneous inflammation. Especially PPAR alpha ligand topically applied not only suppresses mild to moderate dermatitis but also prevent the rebound phenomenon after TC use to experimental allergic dermatitis of mice.6
The rebound phenomenon after prolonged use of TC is initially reported by Kligman as “Steroid addiction†in 1970’s.1 The animal experimental model of rebound after TC use was established by by Grabbe in 1995.7 Several studies which prevent or suppress rebound flare after TC use are reported using Grabbe’s murine model since then.8,9 Severe rebound flare developed to the whole body was reported by Rapaport as “Red skin syndromeâ€.2 The serial phenomena from prolonged use of corticosteroids to rebound flare after discontinuance are called “Topical corticosteroid addiction†(TCA) by some patients and patients’ groups.10
Clofibrate is one of PPAR alpha ligand and formulated as an oral capsule medication for patients with hyperlipidemia. It is easy to prepare topical clofibrate from capsules for clinicians and seems to be useful if it could suppress AD without rebound flare after cessation of TC. As clofibrate is old and cheap medication and no adverse event has been reported about carcinogenicity or immune-suppression, patients with steroid-phobia might accept that “gentle†medication and their quality of life would be improved by using topical clofibrate. That is the background of the study and the purpose of the study is to assess the efficacy and safety of topical clofibrate 0.25% first of all.
