Efficacy and tolerability at 3 and 6 months following use of azathioprine for recalcitrant atopic dermatitis in children and young adults

Hon, Kam Lun; Ching, Gary; Leung, Ting Fan; Chow, Chung Mo; Lee, Kenneth K. C.; Ng, Pak Cheung

doi:10.1080/09546630802512646

Cited by 51 publications

(44 citation statements)

References 13 publications

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“…After 3 months of therapy, 28 patients (58.3%) showed excellent results and 13 patients (27.1%) showed good improvement, whereas only 7 patients (14.6%) showed little or no improvement. In 2009, another retrospective uncontrolled study including 17 patients (mean age of 16.1 ± 3.9 years) with recalcitrant AD showed significant improvement of SCORAD after 3 months and 6 months of treatment with azathioprine as well as significant reduction in total serum IgE levels [73]. Azathioprine has an intriguing metabolism with several immunosuppressant metabolites, governed by thiopurine methyltransferase activity (TPMT), so that the azathioprine dosage should be determined based on the TPMT genotype or activity levels to limit the possible appearance of myelotoxicity.…”

Section: Methodsmentioning

confidence: 99%

Systemic Treatment of Adult Atopic Dermatitis: A Review

Megna

Napolitano

Patruno

et al. 2016

Dermatol Ther (Heidelb)

133

109

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Atopic dermatitis (AD) is a common chronic inflammatory skin disease that predominantly affects children. However, it can persist in adulthood and/or start at older ages. Due to its chronic nature and frequently occurring relapses, AD has a substantial effect on patients' quality of life, often requiring long-term systemic treatment, especially in adult patients, who are more frequently refractory to adequate topical treatment with mid- to high-potent corticosteroids and/or calcineurin inhibitors. Therefore, treatment with systemic therapies is often needed to take control of the disease, prevent exacerbations and improve quality of life. However, data regarding systemic treatment effectiveness and long-term safety in adult patients with AD are insufficient. Indeed, standardized international guidelines are lacking, and the treatment approach widely differs among diverse countries. This review focuses on the use of systemic treatments in adult AD patients analyzing published literature.

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Section: Methodsmentioning

confidence: 99%

Systemic Treatment of Adult Atopic Dermatitis: A Review

Megna

Napolitano

Patruno

et al. 2016

Dermatol Ther (Heidelb)

133

109

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“…Use is generally recommended for those children whose dermatitis is recalcitrant, or when there is significant psychosocial impact on the patient and family unit. 50, 51 Insufficient data exists to recommend an optimal dose, duration of therapy, or to predict the relapse rate upon discontinuation. However, the most common dosage given is 2.5 mg/kg/day, with a higher treatment range maximum of 4 mg/kg/day relative to adult dosing (maximum 3 mg/kg/day).…”

Section: Azathioprinementioning

confidence: 99%

Guidelines of care for the management of atopic dermatitis

Sidbury

Davis

Cohen

et al. 2014

Journal of the American Academy of Dermatology

732

290

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Atopic dermatitis (AD) is a chronic, pruritic inflammatory dermatosis that affects up to 25% of children and 2-3% of adults. This guideline addresses important clinical questions that arise in AD management and care, providing recommendations based on the available evidence. In this third of four sections, treatment of AD with phototherapy and systemic immunomodulators, antimicrobials, and antihistamines is reviewed, including indications for use and the risk-benefit profile of each treatment option.

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“…Only a few controlled studies with long-term use of AZA in AD patients are published1,19. A significant improvement of the AD lesions, a reduction of total serum IgE levels and moderate side effects have been reported in a recent pediatric study running over three months45. Infections, skin cancer, gastrointestinal disturbances, hepatotoxicity and rare but severe bone marrow suppression are typical side effects of AZA.…”

Section: Systemic Anti-inflammatory Therapymentioning

confidence: 84%

Long Term Treatment Concepts and Proactive Therapy for Atopic Eczema

2012

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Atopic eczema, also known as atopic dermatitis, is a frequent, highly pruritic, chronic skin disease, which is typically running in flares. The traditional treatment mainly consists of the reactive application of topical anti-inflammatory agents such as topical corticosteroids and topical calcineurin inhibitors. The short term benefit of this approach is well known, but long term remission between flares is difficult to achieve. Therefore, innovative long-term treatment strategies targeting flare prevention and skin barrier stabilization are needed. We and others have shown that normal looking, non-lesional skin of atopic dermatitis patients is immunobiologially not normal but characterized by an invisible inflammation and barrier defect. This has led to the novel concept of proactive therapy, which is defined as long-term, low-dose intermittent application of anti-inflammatory therapy to the previously affected skin, together with an ongoing emollient treatment of unaffected skin. This review article describes the most important long-term treatment options for atopic dermatitis, which includes emollient therapy, the novel concept of proactive treatment, the different ultraviolet light modalities and a selection of systemic immunosuppressive drugs and biologics. Current trial data, licensed indications, off-label use and relevant side effects of the different treatment modalities are summarized.

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Efficacy and tolerability at 3 and 6 months following use of azathioprine for recalcitrant atopic dermatitis in children and young adults

Abstract: Azathioprine reduced the disease severity of AD within 3 months of use in these children. Better efficacy was observed in females at 6 months. Adverse hematologic and biochemical effects appeared acceptable but longer-term monitoring is desirable.

Cited by 51 publications

References 13 publications

Systemic Treatment of Adult Atopic Dermatitis: A Review

Systemic Treatment of Adult Atopic Dermatitis: A Review

Guidelines of care for the management of atopic dermatitis

Long Term Treatment Concepts and Proactive Therapy for Atopic Eczema

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