ABSTRACT
BACKGROUND: In a small number of cases of childhood atopic dermatitis, topical therapy is ineffective, necessitating prolonged use of systemic immunosuppressants. Over the last few years, a better understanding of the metabolic pathways involved in azathioprine breakdown has enabled us to use this drug more safely. In this study, we evaluated the toxicity of azathioprine treatment adjusted to thiopurine methyltransferase activity in children with severe atopic dermatitis. MATERIAL AND METHODS: We performed a retrospective study of the side effects of azathioprine therapy adjusted to thiopurine methyltransferase activity in children aged under 14 years with atopic dermatitis who were treated in the dermatology department of Hospital Universitario Insular de Gran Canaria in Gran Canaria, Spain. Side effects were evaluated by analysis of leukocyte count and transaminase levels at baseline, after 1 month of treatment, and every 3 months thereafter. RESULTS: During the last 4 years, 7 children (mean age, 10 years) with severe atopic dermatitis received azathioprine in our department. Mean duration of treatment was 12 months (range, 1 to 38 months). Only 2 patients presented mild transient leukopenia that did not require treatment to be suspended. DISCUSSION: Our experience shows that, when adjusted to thiopurine methyltransferase activity, azathioprine is a safe drug for the treatment of children with severe atopic dermatitis. However, clinical trials should be performed to compare the risk-benefit ratios of the different immunosuppressants used to treat these patients.
Subject(s)
Azathioprine/adverse effects , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/enzymology , Immunosuppressive Agents/adverse effects , Methyltransferases/metabolism , Adolescent , Azathioprine/therapeutic use , Child , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Retrospective Studies , Severity of Illness IndexABSTRACT
El estudio histopatologico con hematoxilina y eosina se la principal fuente de informacion para el medico. Pero sumados al estudio morfologico, una serie de analisis inmunologicos, citogenicos y moleculares puede ayudar a un diagnostico certero. Las poblaciones celulares pueden identeificarse de acuerdo a las expresion de diferentes antigenos de superficie (marcadores). El empleo actual de AC monoclonales contra estos Ag colabora en la inmunotipificacion y por lo tanto con la individualizacion de las poblaciones celulares. El uso anarquico de diferentes nombres o acronimos pa Ac que estaban dirigidos contra el mismo Ag confundia la interpretacion de los resultados. Nuestra intencion fue elaborar un cuadro donde el medico encuentre la nomenclatura actualizada hasta el workshop de 1993-29, los sinonimos y las celulas o grupos de celulas que poseen el el Ag que puede detectar cada Ac. La deteccion de marcadores linfocitarios medieante un amplio panel de Ac complementa pero no sustituye la valoracion de la microscopia convencional. Si se emplea un grupo restringido de Ac puede confundirse el diagnostico. Se recomienda como minimo utilizar los siguientes Ac.Celulas T: CD1, CD2, CD3, CD4, CD5, CD7, CD8. Celulas B: CD19, CD20, CD21, CD22. ig superficie (A,G,M yD), cadena kappa y lambda. Serie mielomonocitica: CD!ú; CD! $; CDúú; CD&$; CD& (.Celulas progenitoras:CD38. Marcadores de proliferacion:CD38,CD71.