Efficacy of Methotrexate versus Azathioprine and Their Steroid Sparing Role in the Treatment of Chronic Actinic Dermatitis: A Randomized Control Trial

Author(s): Mohammad Majid Paracha, Abdul Qayum khan, Farah Sagheer, Hina Zahoor

Background

Azathioprine is first line immunosuppressive agent in treatment of chronic actinic dermatitis. Steroid sparing role of methotrexate has been effective in different dermatosis and it seems reasonable to use it in the treatment of chronic actinic dermatitis.

Methods

Patients with chronic actinic dermatitis were randomized to receive methotrexate and systemic steroids in group A and azathioprine and systemic steroids in group B. Tapering of systemic steroids was started at 4 weeks. The response to treatment, exacerbation of disease and side effects of medications were assessed at 4, 8 and 16 weeks follow-up by calculating percentage PASI reduction.

Result

Among 168 patients, 35(38.09%) patients in group A and 37(44%) patients in group B showed efficacy to the treatment at 4 weeks. On follow-up at 16 weeks, exacerbation of skin lesions was observed in total of 14 (19.44%) patients on tapering of systemic steroids among 72 (42.9%) patients previously showing efficacy to the combination therapy, with 9(24.71%) patients in group A and 5(13.51%) patients in group B.

Conclusion

This study shows that methotrexate and azathioprine are effective in the treatment of chronic actinic dermatitis in the presence of systemic steroids but there was exacerbation of skin lesions in few patients on tapering of steroids. Disease exacerbation was significantly more in patients on methotrexate as compared to patients on azathioprine used as steroid sparing agent.