Azathioprine as a Corticosteroid Sparing Agent for the Treatment of Dermatitis Caused by the Weed Parthenium

Abstract

Air-borne contact dermatitis caused by Parthenium hysterophorus is a serious problem in India. Patients with this condition have to use corticosteroids regularly in order to maintain clinical remissions, but prolonged usage causes serious side-effects. The weed cannot be eradicated. We have used 3 therapeutic regimens with azathioprine, which led to an effective control with minimal side-effects even when used for long periods. A total of 22 patients (group I) were given 50 mg azathioprine twice a day; 11 patients (group II) received 50 mg azathioprine per day and 300 mg azathioprine every 28 days, and 10 patients (group III) were given 50 mg azathioprine twice a day along with 300 mg azathioprine every 28 days. The duration of treatment varied from 6 months to 3 years. Twenty patients in group I and 9 patients each in groups II and III had complete remission. Nine, 7 and 6 patients in the respective groups needed additional oral betamethasone 1-2 mg per day for brief periods only during the peak season in order to maintain complete remission. One patient in each group had only partial relief. The need for oral betamethasone during the second and the third year was further reduced. One patient each in group I and group II could not continue azathioprine due to the side-effects of the drug.

Azathioprine in dermatology: The past, the present, and the future

“…142,143 Interest in azathioprine for the treatment of psoriasis appears to have waned, but several recent publications have documented its successful use in adult and childhood eczema. Of all the evidence supporting the use of azathioprine in dermatology, its use in eczematous diseases appears to be the strongest.…”

Weekly azathioprine pulse versus daily azathioprine in the treatment of Parthenium dermatitis: A non-inferiority randomized controlled study

“…[3,4] Azathioprine, a 6-mercaptopurine derivative, is a strong immunosuppressive agent which acts by inhibiting activated T-lymphocytes and also has a potent anti-inflammatory effect. It has been demonstrated to be very effective in the treatment of Parthenium dermatitis [7,8] due to its profound effect on T-lymphocytes, [5] the cells mainly responsible for causing dermatitis. The safety and toxicity of azathioprine have been well studied and the drug has been found to be safe even on long term use without significant side effects.…”

“…[3,4] Azathioprine, an immunosuppressive drug, which acts by inhibiting the activated T lymphocytes, has emerged as an effective and safe alternative. [5] In earlier studies, we demonstrated that azathioprine 100 mg daily was effective, [6][7][8] safe for long-term use, and could induce lasting remissions in Parthenium dermatitis. [9] In a small open study, we also demonstrated that 300 mg weekly pulse doses of azathioprine was not only effective and safe in the treatment of Parthenium dermatitis, but reduced the cost of treatment by 60% and encouraged compliance (since only four doses of the drug were taken in a month).…”

An Overview of Airborne Contact Dermatitis

“…In addition to airborne factor, penetration through clothing and inhalation may play role in generalization. To assess the severity of Air borne contact dermatitis, there is a Clinical Severity Score (CSS) put forward by Verma et al [36]. ABCD can also be subclassified as plant or non-plant origin [37].…”