title: Azathioprine treatment of intractable pruritus: A retrospective review.
abstract: BACKGROUND
  Chronic, severe, treatment-resistant and life-altering pruritus is challenging for both clinician and patient. Pruritus in this population of patients may be immune mediated and respond to immunosuppression, but this approach to treatment has not been investigated in depth.
  
  
  OBJECTIVE
  We sought to determine the efficacy and tolerability of azathioprine in the treatment of chronic pruritus responsive to systemic corticosteroids.
  
  
  METHODS
  This was a retrospective review of the outcomes of treatment in 96 patients with systemic steroid-responsive pruritus treated with azathioprine.
  
  
  RESULTS
  Mean duration of symptoms before treatment was 52.9 months (range 2-360 months, SD 64.8); pretreatment visual analog scale itch score was 9.25/10 (range 3-10, SD 1.37); posttreatment itch was 1.625/10 (range 0-8, SD 1.67) (P < .0001). Suspected drug-related adverse effects developed in 62 (65%) patients and 32 (33%) patients had to permanently discontinue treatment.
  
  
  CONCLUSIONS
  Because of the uncontrolled retrospective design there were variations in azathioprine dosing.
  
  
  CONCLUSIONS
  Among patients with an extensive history of intractable and life-altering pruritus, therapy with azathioprine may provide substantial relief of symptoms.
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Maley
authors.affiliation: Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: rswerli@emory.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swerlick
mesh_terms: D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011537:Pruritus / Q000175:diagnosis* / Q000188:drug therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D001379:Azathioprine
keywords: azathioprine; corticosteroids; immunology; immunosuppression; itch; pruritus; quality of life; thioguanine