RATIONALE: Severe recalcitrant local atopic dermatitis complicated by keratoconjunctivitis and corneal ulceration may lead to severe visual impairment. We report a patient who failed conventional topical treatment and systemic cyclosporin who responded well to mycophenolate without adverse reactions.METHODS: A case report.RESULTS: A 38 year-old male with a history of allergic rhinitis, eyelid atopic dermatitis, keratoconjunctivitis, and corneal ulcerations presented to our clinic in 2003 with recalcitrant disease. Symptoms included 13 years of eyelid swelling, pain, and severe pruritis. Previous treatment modalities included topical and oral steroids, pimecrolimus, emollients, topical and oral cyclosporin, and enviromental control measures. The oral steroids had provided the best relief of symptoms, however, long term use due to possible steroid-related side effects limited its usage. Initial IgE level was significantly elevated at 7245 IU/ml and therapy with mycophenolate 1000 mg daily was initiated. After 3 months of treatment, his IgE level fell to 2880 IU/ml and the patient had marked improvement of symptoms. Four months later, the patient's symptoms worsened and his IgE had rebound to 5061 IU/ml. At that point, mycophenolate was increased to 1500 mg daily. Six weeks later he reported improvement of symptoms and his IgE had fallen to 4549 IU/ml. Under this treatment, he also had marked improvement in his allergic rhinitis. Thus far, the patient has not had adverse reactions.CONCLUSIONS: This case indicates that mycophenolate is an excellent alternative to conventional treatment of atopic dermatitis. RATIONALE: Severe recalcitrant local atopic dermatitis complicated by keratoconjunctivitis and corneal ulceration may lead to severe visual impairment. We report a patient who failed conventional topical treatment and systemic cyclosporin who responded well to mycophenolate without adverse reactions. METHODS: A case report. RESULTS: A 38 year-old male with a history of allergic rhinitis, eyelid atopic dermatitis, keratoconjunctivitis, and corneal ulcerations presented to our clinic in 2003 with recalcitrant disease. Symptoms included 13 years of eyelid swelling, pain, and severe pruritis. Previous treatment modalities included topical and oral steroids, pimecrolimus, emollients, topical and oral cyclosporin, and enviromental control measures. The oral steroids had provided the best relief of symptoms, however, long term use due to possible steroid-related side effects limited its usage. Initial IgE level was significantly elevated at 7245 IU/ml and therapy with mycophenolate 1000 mg daily was initiated. After 3 months of treatment, his IgE level fell to 2880 IU/ml and the patient had marked improvement of symptoms. Four months later, the patient's symptoms worsened and his IgE had rebound to 5061 IU/ml. At that point, mycophenolate was increased to 1500 mg daily. Six weeks later he reported improvement of symptoms and his IgE had fallen to 4549 IU/ml. Under this treatment, he also had marked improvement in his allergic rhinitis. Thus far, the patient has not had adverse reactions. CONCLUSIONS: This case indicates that mycophenolate is an excellent alternative to conventional treatment of atopic dermatitis.