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Guidelines for prescribing azathioprine in dermatology

Authors

  • A.V. ANSTEY,

    1. Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, U.K.
      *Department of Dermatology, St Mary's Hospital, Praed Street, London W2 1NY, U.K.
      †Department of Dermatology, School of Clinical and Laboratory Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K.
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  • S. WAKELIN,

    1. Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, U.K.
      *Department of Dermatology, St Mary's Hospital, Praed Street, London W2 1NY, U.K.
      †Department of Dermatology, School of Clinical and Laboratory Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K.
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  • N.J. REYNOLDS

    1. Department of Dermatology, Royal Gwent Hospital, Cardiff Road, Newport, Gwent NP20 2UB, U.K.
      *Department of Dermatology, St Mary's Hospital, Praed Street, London W2 1NY, U.K.
      †Department of Dermatology, School of Clinical and Laboratory Sciences, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne NE2 4HH, U.K.
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  • These guidelines were commissioned by the British Association of Dermatologists Therapy, Guidelines and Audit Subcommittee. Members of the committee are A.D.Ormerod (Chairman), A.S.Highet, D.Mehta, R.H.Meyrick Thomas, C.H.Smith, J.C.Sterling and A.Anstey. Conflicts of interest: No additional funding was received by the authors of these guidelines to support this work. None of the authors has a conflict of interest to declare.

Alex Anstey.
E-mail: alex.anstey@gwent.wales.nhs.uk

Summary

Azathioprine has been available as an immunosuppressive agent for over 40 years, and current routine usage in dermatology is not restricted to licensed indications. Advances in understanding the metabolic fate of azathioprine have led to significant changes in prescribing practice and toxicity monitoring by U.K. dermatologists. The current state of knowledge concerning the use of azathioprine in dermatology is summarized, with identification of strength of evidence. Clinical indications and contraindications for azathioprine usage in dermatology are identified. Evidence-based recommendations are made for routine safety monitoring of patients treated with azathioprine, including pretreatment assessment of red blood cell thiopurine methyltransferase activity.

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