Premium
A double‐blind controlled trial of azathioprine in chronic actinic dermatitis
Author(s) -
Murphy G.M.,
Maurice P.D.L.,
Norris P.G.,
Hawk J.L.M.
Publication year - 1987
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.1987.tb11996.x
Subject(s) - medicine , rash , itching , azathioprine , placebo , dermatology , photodermatosis , surgery , pathology , xeroderma pigmentosum , dna , genetics , alternative medicine , disease , biology , dna damage
Chronic actinic dermatitis is a rare, idiopathic, eczematous photodermatosis which is usually severe and refractory to treatment, although spontaneous improvement may occur. 1 Retrospective assessment has indicated that azathioprine may be a useful mode of treatment. 2 A doubleblind controlled trial was therefore carried out to confirm its efficacy. All patients were investigated by irradiation monochromator testing of the skin of the back to establish abnormal reactions to ultraviolet (UV) and visible radiation. Patch and photopatch tests excluded causative allergic contact and photocontact dermatitis. Eighteen severely affected patients were sequentially and randomly allocated to azathioprine 50 mg t.d.s. or placebo therapy over a 2year period. Patients wore polysulphonefilm lapel badges, changed weekly throughout the trial. The change in absorbance of the polysulphone film as measured spectrophotometrically before and after exposure enabled quantification of ambient exposure to UVB radiation. Patients documented severity of itching and rash weekly on a 10 cm visual analogue scale. Rash, corticosteroid use and sunscreen use were assessed monthly at the clinic, as were haematology, liver function and renal function. Six men and two women (mean age 64 years) received active and 10 men (mean age 66 years) placebo therapy. Patients on active treatment had more severe clinical features and monochromator test reactions than those on placebo at the start of the trial. Mean duration of treatment was 8·4 months, range 1·5–12 months (active group) and 4·1 months, range 0·1‐12 months (placebo group). Mean weekly UV exposure was greater in active group patients. Five of eight azathioprine‐treated patients achieved remission and one improved within 3–12 months, one did not improve over 8 weeks and one defaulted early with gastrointestinal upset. None of 10 placebo patients improved, three defaulted within 1 month, the remainder being assessed for 3–12 months. The markedly and significantly better clinical status of actively treated patients ( P ≤0·001; chi‐squared test) led to early termination of the trial. Thus azathioprine therapy is a well‐tolerated effective treatment in chronic actinic dermatitis.