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Background: Background atopic dermatitis patients generally respond to conventional therapies. A small proportion of them have severe disease despite intensive treatment. Efficacy of intravenous immunoglobulin (IVIg) in severe, refractory atopic dermatitis has been reported. Materials and methods: We present the cases of five children with severe atopic dermatitis. All patients were previously and/or currently treated with systemic steroids, phototherapy and a large selection of topical agents. Immunosupressive therapy was refused by their legal representatives. Due to financial restraints, low dose IVIg was administered (approximately 0.3 g/kg/month for six months), while the corticosteroid dose was tapered. Disease outcome was measured using the eczema area and severity index (EASI) and the children’s dermatology life quality index (CDLQI). Results: All five patients experienced clinical improvement with significantly reduced EASI and CDLQI scores. No adverse reactions were reported. During the six months follow-up period, no disease flare occured in any of the patients. Conclusions: Adjunctive IVIg is a useful therapeutic approach in selected patients with refractory atopic dermatitis. Even if most of the reported cases refer to high dose IVIg, low dose regimens are not to be discarded, since they can provide satisfactory results with reduced in-patient costs and high compliance. [ABSTRACT FROM AUTHOR]