Value of Azathioprine in Controlling Vitiligo Activity

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).

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.

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 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.

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

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.