Azathioprine: its uses in dermatology<sup>,</sup>

Chavez-Alvarez, Sonia; Herz-Ruelas, Maira; Villarreal-Martinez, Alejandra; Ocampo-Candiani, Jorge; Garza-Garza, Rubicela; Gomez-Flores, Minerva

doi:10.1016/j.abd.2020.05.003

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Review • An. Bras. Dermatol. 95 (6) • Nov-Dec 2020 • https://doi.org/10.1016/j.abd.2020.05.003 linkcopy

Azathioprine: its uses in dermatology^☆^,^☆☆

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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.

KEYWORDS
Autoimmunity; Azathioprine; Pemphigus

TPMT levels	Dosage of azathioprine
<5 U	Contraindicated
5-13.7 U	Up to 0.5 mg/kg/day
13.7-19 U	Up to 1.5 mg/kg/day
>19 U	Up to 2.5 mg/kg/day

Relative	Absolute
Use of allopurinol	6 MP hypersensitivity or azathioprine
Previous treatment with cyclophosphamide or chlorambucil	Severe active infection
Renal failure	Altered liver function
Viral hepatitis, HIV	Altered bone marrow function
Previous infection by VZV	Pancreatitis
Pre-malignancy	Live virus vaccines
Pre-malignancy	Pregnancy/breastfeeding

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[TFN1] Adapted from Patel et al.⁴

Azathioprine: its uses in dermatology☆,☆☆

Azathioprine: its uses in dermatology^☆^,^☆☆