The efficacy of combined PUVA and low-dose azathioprine for early and enhanced repigmentation in vitiligo patients.

BACKGROUND

Immunosuppressive agents are used widely in the treatment of vitiligo. Corticosteroids are used either alone or as adjuvant therapy by many practitioners. Cyclophosphamide and cycloporine-A have also been used with variable success. Azathioprine may have the potential for the treatment of vitiligo alone or in combination with other modalities.

OBJECTIVE

To compare the efficacy of combined low-dose azathioprine and oral PUVA therapy versus oral PUVA therapy alone for the treatment of vitiligo.

PATIENTS AND METHODS

A total of 60 vitiligo patients were randomized to receive either azathioprine (0.6-0.75 mg/kg) and oral PUVA therapy (group 1) or oral PUVA therapy alone (group 2). Patients were followed for 4 months. A graph transparency with squares of 2.5 x 2.5 mm was used to measure the rate of repigmentation after 4 months of therapy.

RESULTS

Perifollicular repigmentation started after a mean of five sessions in group 1, and eight sessions in group 2. The mean total repigmentation rate after 4 months was 58.4% for group 1 and 24.8% for group 2. No serious side effects were seen during or after treatment.

CONCLUSION

Azathioprine may potentiate the repigmentary effects of PUVA therapy in vitiligo patients. A limitation of the study is the lack of validated measures for vitiligo assessment.