EFFICACY OF METHOTREXATE VERSUS AZATHIOPRINE IN THE TREATMENT OF CHRONIC ACTINIC DERMATITIS: A RANDOMIZED CONTROL TRIAL

Authors

  • Mohammad Majid Paracha Dermatology
  • Hina Zahoor Gandapur Dermatology Deptt MTI/LRH
  • Abdul Qayyum Orakzai Dermatology Deptt MTI/LRH
  • Sahibzad Mahmood Noor
  • Farah Sagheer

DOI:

https://doi.org/10.55519/JAMC-03-S1-9643

Keywords:

chronic actinic dermatitis, efficacy safety methotrexate azathioprine

Abstract

Background: Azathioprine is first line immunosuppressive agent in treatment of chronic actinic dermatitis. The role of methotrexate has been effective in different dermatosis and it seems reasonable to use it in the treatment of chronic actinic dermatitis. Aims: We sought to compare the efficacy of methotrexate versus azathioprine in treatment of chronic actinic dermatitis. Methods: Patients with chronic actinic dermatitis were randomized to receive methotrexate in group A and azathioprine in group B. The response to treatment in terms of percentage PASI reduction and side effects of medications were assessed 12 weeks follow-up. Results: In group A, the percentage PASI reduction was <25% in 2 (1.19%) patients, 25-49% in 47 (27.9%) patients, 50-74% was achieved by 35 (20.8%) patients while in group B, the percentage PASI reduction of 25% was achieved by 2 (1.19%) patients, 25-49% in 45 (26.7%) patients, 50-74% in 37 (22.0%) patients. More than or equal to 75 percentage PASI reduction was not achieved by any patient in the study. Both drugs were found efficacious in treatment of CAD. A total of 23 (27.38%) patients in group A and 22 (26.19%) patients in group B showed derangement in laboratory investigations during 12 weeks treatment. The limitation of study was inability to do photo-patch test, so patients were diagnosed clinically and biopsy was done in clinically challenging cases. Conclusion: This study shows that methotrexate is equally effective as azathioprine in the treatment of chronic actinic dermatitis with its added benefits of being cost effective and better safety profile.

Author Biographies

Hina Zahoor Gandapur, Dermatology Deptt MTI/LRH

Working as specialist Registrar at deptt of Dermatology LRH peshawar

Research of literature and data collection 

Data analysed

Abdul Qayyum Orakzai, Dermatology Deptt MTI/LRH

working as Assistant Prof of Dermatology MTI/LRH peshawar

Data collection and writing manuscript

 

References

Paek S, Lim H. Chronic Actinic Dermatitis. Dermatol Clin 2014;32(3):355-61.

Sidiropoulos M, Deonizio J, Martinez-Escala ME, Gerami P, Guitart J. Chronic Actinic Dermatitis/Actinic Reticuloid. Am J Dermatopathol 2014;36(11):875-81.

Roelandts R. Photodermatology over the past 125 years. Br J Dermatol 2014;171(5):926-8.

Tan K, Haylett A, Ling T, Rhodes L. Comparison of demographic and photobiological features of chronic actinic dermatitis in patients with lighter vs darker skin types. JAMA Dermatol 2017;153(5):427.

Ibbotson S, Dawe R. Cutaneous photosensitivity diseases. In: Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D, Rook A, editors. Rook's textbook of dermatology. Vol 4. 9th ed. Wiley-Blackwell: 2016: p.1-127.35.

Agarwal P, Agarwal U, Meena R, Sharma P. A combination of oral azathioprine and methotrexate in difficult to treat dermatoses. Indian J Dermatol Venereol Leprol 2017;83(3):389-92.

Warren RB, Mrowietz U, von Kiedrowski R, Niesmann J, Wilsmann-Theis D, Ghoreschi K, et al. An intensified dosing schedule of subcutaneous methotrexate in patients with moderate to severe plaque-type psoriasis (METOP): a 52 week, multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017;389(10068):528-37.

Paracha MM, Noor SM, Irfanullah, Gafoorullah, Khan AQ. Efficacy and safety of methotrexate in chronic actinic dermatitis: a pilot study. Khyber Med Univ J 2018;10(3):124-6.

Naqqash S, Asad F, Pal SS. Efficacy and safety of azathioprine in chronic actinic dermatitis. J Pak Assoc Dermatol 2010;20(4):222-6.

Kadam P, Bhalerao S. Sample size calculation. Int J Ayurveda Res 2010;1(1):55-7.

Murphy GM, Maurice PD, Norris PG, Moris RW, Hawk JL. Azathioprine in chronic actinic dermatitis: a double-blind controlled trial with monitoring of exposure to ultraviolet radiation. Br J Dermatol 1989;121:639-46.

Callen JP, Spencer LV, Burruss JB, Holtman J. Azathioprine: an effective, corticosteroid sparing therapy for patients with recalcitrant cutaneous lupus erythematosus or with recalcitrant cutaneous leukocytoclastic vasculitis. Arch Dermatol 1991;127(4):515-22.

Dawe RS, Ferguson J. Diagnosis and treatment of chronic actinic dermatitis. Dermatol Ther 2003;16(1):45-51.

Lim HW, Buchness MR, Ashinoff R, Soter NA. Chronic actinic dermatitis: study of the spectrum of chronic photosensitivity in 12 patients. Arch Dermatol 1990;126(3):317-23.

Yap LM, Foley P, Crouch R, Baker C. Chronic actinic dermatitis: a retrospective analysis of 44 cases referred to an Australian photobiology clinic. Australas J Dermatol 2003;44(4):256-62.

Dawe RS. Chronic actinic dermatitis in the elderly. Drugs Aging 2005;22(3):201-7.

Artz CE, Farmer CM, Lim HW. Chronic Actinic Dermatitis: A Review. Curr Dermatol Rep 2019;8(3):104-9.

Que SK, Brauer JA, Soter NA, Cohen DE. Chronic actinic dermatitis: an analysis at a single institution over 25 years. Dermatitis 2011;22(3):147-54.

Scerri L. Azathioprine in dermatological practice. An overview with special emphasis on its use in non-bullous inflammatory dermatoses. Adv Exp Med Biol 1999;455:343-8.

Downloads

Published

2022-06-24

How to Cite

Paracha, M. M., Gandapur, H. Z., Orakzai, A. Q., Sahibzad Mahmood Noor, & Farah Sagheer. (2022). EFFICACY OF METHOTREXATE VERSUS AZATHIOPRINE IN THE TREATMENT OF CHRONIC ACTINIC DERMATITIS: A RANDOMIZED CONTROL TRIAL. Journal of Ayub Medical College Abbottabad, 34(3 (SUPPL 1). https://doi.org/10.55519/JAMC-03-S1-9643

Issue

Vol. 34 No. 3 (SUPPL 1) (2022): JOURNAL OF AYUB MEDICAL COLLEGE ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.