Abstract
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. We sought to determine the efficacy and tolerability of azathioprine in the treatment of chronic pruritus responsive to systemic corticosteroids. This was a retrospective review of the outcomes of treatment in 96 patients with systemic steroid-responsive pruritus treated with azathioprine. Mean duration of symptoms before treatment was 52.9months (range 2-360months, 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. Because of the uncontrolled retrospective design there were variations in azathioprine dosing. Among patients with an extensive history of intractable and life-altering pruritus, therapy with azathioprine may provide substantial relief of symptoms.
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