No abstract available.
Azathioprine* ; Dermatitis, Atopic* ; Humans

Azathioprine is the most common drug used to maintain clinical remission in inflammatory bowel disease. This drug is also important as a steroid-sparing agent in steroid-dependent and chronically active inflammatory bowel disease. Nevertheless, many questions remain concerning the optimal treatment regimens of azathioprine. The dose of azathioprine has to be reduced or the therapy has to be discontinued frequently because of drug-induced toxicity. In this review, we discuss monitoring of thiopurines, adverse events, malignant complications and how to use azathioprine safely and usefully.
Azathioprine ; Inflammatory Bowel Diseases

No abstract available.
Azathioprine ; Encephalomyelitis ; Myoclonus ; Steroids

Introduction: Pemphigus vulgaris is a life-threatening, autoimmune bullous disease caused by desmogleins (Dsg) 1 and 3 au- toantibodies. It is a rare disease with an incidence rate of 0.5 to 3.2 per 100,000 per year. It typically presents as painful, flaccid blisters and erosions on both the skin and mucous membranes. Case report: We present a 43-year-old male with painless penile erosions of 1-month duration. He was evaluated for sexually transmitted infections, but laboratory tests yielded negative results. Subsequently, vesicles and bullae on the back and hyper- keratotic lesions on the malar area appeared, leading to the differential diagnoses of bullous diseases. Skin biopsy was done revealing intraepidermal suprabasal blisters with acantholytic cells. Direct Immunofluorescence demonstrated positive inter- cellular deposits of IgG and C3. ELISA Dsg 1 and Dsg 3 were positive (ratio of 1.857 and 4.580, respectively). A final diagnosis of pem- phigus vulgaris (PV) was made. The patient has remained in remission after a 3-month course of prednisone and azathioprine. Conclusion This is a unique case of PV presenting with an unusual manifestation of painless penile erosions. There have been limited reports of PV with penile skin involvement and all cases presented with painful lesions. Because painless penile lesions as presenting feature is rare, the diagnosis may be easily missed. This case demonstrates that thorough dermatologic examination and early diagnosis despite atypical findings are crucial to provide timely and appropriate treatment as this determines the clinical outcome of the disease.
Pemphigus ; Desmogleins ; Azathioprine

No abstract available.
Azathioprine* ; Child* ; Humans ; Nephritis* ; Purpura*

BACKGROUND: Alopecia areata (AA) is an autoimmune hair disorder, with the clinical variants ophiasis and extensive variants AA totalis and universalis, having poor response to therapy. Oral steroids are used to treat the severe variants, requiring prolonged therapy, which leads to side effects while discontinuation leads to high relapse rate. Azathioprine is a steroid-sparing agent for the severe AA forms.

OBJECTIVE: To review the current evidence on the therapeutic efficacy and adverse effects of azathioprine for severe forms of alopecia areata

METHODS: Published articles utilizing azathioprine for alopecia areata were obtained until July 2018 from PubMed, MEDLINE, Cochrane Library, TRIP database, HERDIN, and Google Scholar.

RESULTS: Seven articles underwent a full-length review. Clinical variants include patchy, diffuse, steroid-resistant, reticulate, totalis, universalis, ophiasis, and sisaipho. Doses ranged from 2 to 2.5 mg/kg/day or weekly 5 mg/kg pulse therapy. Initial response ranged from 6 to 12 weeks, with almost complete resolution by 32 weeks. Response was sustained for 6 months upon discontinuation, with only 14% relapsing at 2.5 months. Adverse effects were gastrointestinal discomfort, elevated liver function tests, and myelosuppression.

CONCLUSION: There is emerging evidence on the efficacy and safety of azathioprine for the treatment of extensive forms of alopecia areata. Randomized-controlled trials are needed to evaluate its efficacy.

Proper hand scrubbing is very important for the prevention of food poisoning. The scrubbing checker is a method for determining the level of cleanliness based on light emitted from the hands after washing with a lotion containing fluorescence. In March 2008, we examined the hands of 33 individuals on the staff of the Department of Dietetics, Konan Kosei Hospital, using the ATP wipe test and the scrubbing checker. We also investigated the effectiveness of sanitary education using both methods. The ATP wipe test was conducted twice. The first test was done after normal scrubbing, and scrubbing education was given later. In order to evaluate the effectiveness of sanitary education, the second test was done approximately one week after the first test and the ATP levels obtained before and after sanitary education were compared. The measurements were evaluated in three stages:grade A (satisfactory), B (borderline) and C (unsatisfactory). For sanitary education, hand cleanliness was confirmed by each of the participants themselves using the scrubbing checker. In the first test, 58% of those tested were evaluated as grade A. Sanitary education using the scrubbing checker showed that scrubbing of the nails was inadequate in 64% of the examinees. Therefore, education was given about scrubbing the nails against the palm of the other hand. In the second test after scrubbing education, the percentage of those evaluated as gradeA increased to 91%. As a result of these findings, it was concluded that sanitary education using the ATP wipe test and the scrubbing checker is effective. We plan to prevent food poisoning by conducting both tests periodically hereafter.
educational ; Azathioprine ; Hand ; Grade ; Educational Background

Background: There is a dearth of data on Filipino patients with autoimmune hepatitis (AIH). We aimed to describe the demographic and clinical profiles of patients with AIH and to characterize clinical outcomes and treatment responses. Methods: A retrospective cohort study involving patients from two tertiary centers diagnosed with AIH from January 1, 2007, to December 31, 2019, was included. Disease remission was defined as the normalization of ALT levels, while failure was defined as an increase in ALT levels over baseline or clinical deterioration. Results: A total of 48 patients were identified between 2007 to 2019. The median age at presentation was 51 (27-79 yrs.). Liver cirrhosis was already present in 37.5% (27.1% decompensated) on diagnosis. Aside from a higher histologic activity index in females (p=0.047), there were no gender-specific differences. Disease remission was achieved in 41.9% of patients at 6 months, while only 9.3% failed. At the final disposition, remission rates had slightly increased to 58%, but failure rates had risen to 12%. Treatment responses at both 6 and 12 months and MELD and Child-Pugh class influenced treatment responses at final disposition. Median overall survival was 102 weeks and was influenced by the presence of liver dysfunction and 12 months and final treatment responses. Conclusion Autoimmune hepatitis remains an important cause of morbidity and mortality. The results of the study highlight the need for immunosuppressive therapy to induce early remission for a higher likelihood of subsequent biochemical remission to reduce the risk of liver-related mortality.
Autoimmune Hepatitis ; Liver Cirrhosis ; Steroids ; Azathioprine

Delayed pressure urticria is a type of physical urticaria, characterized by the appearance of painful swelling for a few hours after physical stimulus. A 27-year-old woman suffered from pressure urticaria for eight months. The patient was unresponsive to conventional antihistamine, glucocorticoid, cyclosporine and azathioprine. Since the patient was treated with 10 mg/day montelukast and 1 mg/day ketotifen for 10 months, erythema and wheals have not developed. We report a case of pressure urticaria treated with a leukotriene inhibitor.
Acetates ; Adult ; Azathioprine ; Cyclosporine ; Erythema ; Female ; Humans ; Ketotifen ; Quinolines ; Urticaria

Polymyositis is one form of inflammatory myopathy. In some patients, this disease does not entirely respond to conventional initial therapy with glucocorticoid, methotrexate and azathioprine. Multiple options exist for treating these patients, but only intravenous immune globulin has been subjected to a randomized clinical trial. We report here on a case of polymyositis that did not respond to multiple drug therapy, but it did respond to tacrolimus. After treatment with tacrolimus, the patient's disease has been well controlled for many years.
Azathioprine ; Humans ; Immunoglobulins, Intravenous ; Methotrexate ; Myositis ; Polymyositis ; Tacrolimus