THERAPEUTICS BJD British Journal of Dermatology Excimer laser vs. clobetasol propionate 0Æ05% ointment in prurigo form of atopic dermatitis: a randomized controlled trial, a pilot E.E.A. Brenninkmeijer,* P.I. Spuls,* R. Lindeboom, A.C. van der Wal,à J.D. Bos* and A. Wolkerstorfer*§ Departments of *Dermatology,  Clinical Epidemiology, Biostatistics and Bioinformatics and àHistopathology and §Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, the Netherlands Correspondence Elian E.A. Brenninkmeijer. E-mail: E.E.Brenninkmeijer@amc.uva.nl Accepted for publication 3 May 2010 Key words atopic dermatitis, excimer laser, prurigo, randomized controlled trial Conflicts of interest None declared. DOI 10.1111/j.1365-2133.2010.09858.x Summary Background Recent findings have established the 308-nm xenon chloride excimer laser (EL) as a new option in the area of ultraviolet (UV) B phototherapy. As this laser enables high radiant exposure of narrowband UVB and precise targeting of affected skin, it appears to be a promising treatment for the prurigo form of ato- pic dermatitis (AD). Objectives To investigate the efficacy and safety of the EL compared with clobetasol propionate (CP) in the prurigo form of AD. Methods In a prospective randomized within-patient controlled study, 13 patients with a prurigo form of AD were randomized to receive EL on one side and topical CP on the other side. Laser treatment was performed twice a week for 10 weeks. Clinical responses were evaluated using Physician Assess- ment of Individual Signs, Physician Global Assessment, Patient Global Assess- ment and photographic documentation. Histopathological changes were evaluated and duration of remission was monitored during a 6-month follow- up period. Results Both treatments resulted in a significant improvement of all outcome mea- sures after 10 weeks of treatment. During follow up, the EL showed more improvement compared with CP. Histopathology demonstrated marked decrease of epidermal thickness and inflammatory infiltrate at the EL-treated sites. No significant side-effects occurred. Conclusions This study suggests that the EL can safely and effectively be used in the treatment of the prurigo form of AD. For the long term, the EL might be a good alternative to topical corticosteroids and an option in case of therapy-resistant patients. The term prurigo, originating from pruire (itching), was coined by Ferdinand von Hebra in 1850, to characterize typi- cal itching papules and nodules induced by scratching. 1 Since then, various eponyms have arisen. Ernest Henri Besnier (1860) described a chronic lichenoid flexural form of atopic dermatitis (AD) still known as prurigo of Besnier. 2 In 1909, Hyde described an intractable chronic eruption characterized by numerous persistent pruritic nodules mainly on the extremities. 1,3 Until now, Hyde’s prurigo, or prurigo nodular- is (PN), is the genuine chronic form of prurigo. 4 Although emotional factors and repeated scratching have been impli- cated as contributory factors, the cause and pathogenesis of prurigo are not completely understood. 5 PN is generally regarded as a variety of eczema, and in many cases there is a history of AD. Miyachi et al. 5 and Rowland Payne et al. 3 sug- gested that PN can be associated with an atopic background; 60–80% of patients with PN are atopic and up to 46% have AD. 3,5 In 1995, Tanaka et al. demonstrated two types of PN: an atopic and a nonatopic type. The atopic type of PN is accompanied by cutaneous hypersensitivity to environmental allergens. 6 The atopic type of PN can easily be confused with the diagnosis of prurigo of Besnier; however, in prurigo of Besnier the typical nodules are missing. This study focuses on patients with the prurigo form of AD, defined as patients who Ó 2010 The Authors Journal Compilation Ó 2010 British Association of Dermatologists • British Journal of Dermatology 2010 163, pp823–831 823