Azathioprine: its uses in dermatology

Abstract

This is a narrative review of azathioprine. This medication is immunomodulatory and immunosuppressive, and it has been used widely through different medical specialties to modify disease. It has been proven useful for several dermatoses and it has encountered success when used as an off-label indication for other dermatologic diseases. Its mechanism of action is described thoroughly, as well as precautions for monitoring adequate levels in patients using it. Dermatologists should also be aware of the possible adverse events it may present. In dermatology it can be used in bullous and autoimmune diseases, and in other conditions, including intractable pruritus, atopic dermatitis, photodermatoses, psoriasis, and others. Azathioprine offers an alternative as a steroid-sparing agent and this review helps dermatologists prescribe it safely to all patients who require it.

Narrative review on the management of moderate-severe atopic dermatitis in pediatric age of the Italian Society of Pediatric Allergology and Immunology (SIAIP), of the Italian Society of Pediatric Dermatology (SIDerP) and of the Italian Society of Pediatrics (SIP)

“…Azathioprine has lower efficacy than CsA, but comparable to that of methotrexate. The recommended dosage is 2-3 mg/kg/day and it generally takes at least 1-2 months to manifest the beneficial effects [ 139 , 156 ]. The low thiopurine-methyltransferase activity has been associated with increased myelotoxicity, but at-risk patients can be identified before starting azathioprine therapy by testing the activity of this enzyme.…”

“…The most reported side effects associated with the use of azathioprine are gastrointestinal symptoms, myalgia, fever, skin reactions, headache, lymphopenia, and neutropenia. In conclusion, azathioprine is a drug rarely used in the treatment of AD in adults and even less in the pediatric age, in which azathioprine is to be considered an off-label therapy [ 139 , 156 – 158 ].…”

“…Azathioprine is a purine analog that has immunosuppressive activity by inhibiting DNA production, therefore affecting cells with high proliferation rates, such as T and B lymphocytes during the inflammatory disease phases [ 139 , 156 – 158 ].…”

“…Azathioprine can be considered a second-choice therapy for moderate-severe AD in adults when CsA has not shown efficacy or has given side effects or is contraindicated [ 139 , 156 ]. Azathioprine has lower efficacy than CsA, but comparable to that of methotrexate.…”

“…In conclusion, azathioprine is a drug rarely used in the treatment of AD in adults and even less in the pediatric age, in which azathioprine is to be considered an off-label therapy [ 139 , 156 – 158 ].…”