Objective To investigate the safety and efficacy of azathioprine in a childhood population with severe atopic Eczema

Methods We conducted a retrospective review of azathioprine use over an eight year period in a childhood population with refractory atopic eczema. Twenty one patients with severe atopic eczema, 19% of whom had partial enzyme deficiency of thiopurine methyltransferase (TPMT) were included.

Results Azathioprine was commenced at doses ranging from <2 mgs/kg to 2–3 mgs/kg/day. Treatment was withdrawn due to failure to comply with monitoring in 2 cases and treatment was discontinued due to severe thrombocytopenia (28,000/mm³) in 1 child. Of the remaining 18 patients, a total of 16 patients (88.9%) responded to treatment, of whom 7(43.7%) improved significantly within the first 6 weeks of therapy. Treatment durations varied from 6 to 15 months. Of the 16 responders, objective improvement (as assessed by the supervising Physician) at 3 months, was estimated as poor, i.e.<50% in one case (who subsequently improved significantly following a dose increase), as good i.e. 50–80% in 6 individuals (37.5%) and as excellent i.e.>80% in 9 cases (56%). Duration of remission was variable, less than 3 months in one case, 3–12 months in 5 individuals, remission (ranging from 2 to18 months) is ongoing off treatment in 4 patients and 6 patients remain on treatment. Azathioprine was tolerated without side effects in 14 patients (66.7%), one patient developed severe thrombocytopenia and another moderate neutropenia (Partial TPMT deficiency).

Conclusion In summary, azathioprine appears effective and safe for refractory childhood eczema.