Value of Azathioprine in Controlling Vitiligo Activity.

Background: In progressive vitiligo, systemic corticosteroids as oral mini-pulse (OMP) have been successfully used, yet there is limited data regarding other immunosuppressants, such as azathioprine (AZA).

Aim And Objectives: We aimed to evaluate the efficacy and safety of AZA in stabilizing active vitiligo, and compare it with its combined use with narrow - band ultraviolet B (NB-UVB) and OMP combined with NB-UVB.

Patients And Methods: Forty-five adult active non-segmental vitiligo (NSV) patients were randomly and equally divided into three groups. Patients received treatment for 3 months. Patients in Group A received NB-UVB with OMP, those in Group B received NB-UVB combined with oral AZA, and patients in Group C received oral AZA alone. Treatment response was evaluated at 4, 8, and 12 weeks by assessing the cessation of vitiligo activity, the onset of re-pigmentation, and its extent using vitiligo extent score (VES), VES plus, and vitiligo disease activity (VIDA) scores. Encountered side effects were also documented.

Results: Results revealed significant differences between study groups in decrease in VES and VES plus scores (incidence of re-pigmentation) after 12 weeks of treatment (Groups A and B had superior re-pigmentation than Group C). There was no significant difference among the groups in cessation of vitiligo activity (although more patients experienced a faster onset in Group A and B compared to Group C). Encountered side effects were minimal, with no significant difference.

Limitations: Small sample size, short duration of follow-up and not carrying out thiopurine methyl transferase activity.

Conclusion: AZA is effective in controlling vitiligo activity, either as monotherapy or in combination with NB-UVB. However, it is inferior to the combination of OMP with NB-UVB in inducing re-pigmentation. Thus, AZA can be used as a good alternative to stop vitiligo progression when systemic steroids are contraindicated.