Clinical and pathogenetic justification of the use of azathioprine in the treatment of progressive non-segmental vitiligo

Abstract

BACKGROUND: Vitiligo refers to acquired hypomelanosis, characterized by the appearance of depigmented spots on the skin. The search for new vitiligo treatment approaches, which would simultaneously have a pathogenetic focus on the therapy of this disease and at the same time have a safe spectrum of side effects, is relevant today.
 AIM: to evaluate the clinical and laboratory efficacy of azathioprine in progressive non-segmental vitiligo compared with NB-UVB monotherapy.
 MATERIALS AND METHODS: 60 patients with progressive non-segmental vitiligo were divided into 2 equal groups: group 1 received azathioprine in combination with NB-UVB, group 2 received NB-UVB monotherapy. The follow-up period was 6 months. The effectiveness of therapy was evaluated based on the dynamics of the Vitiligo Area Scoring Index (VASI), dermatological quality of life index (DLQI), as well as the titers of proinflammatory cytokines IL-1, IL-2, IL-6, IL-8, IFN-, TNF- and S100 protein in serum blood.
 RESULTS: In the azathioprine + NB-UVB group, compared with the control group, a statistically significant prevalence of VASI and DLQI indices reduction was observed. (Me -61.70%, Q1Q3: -75.14-47.08%, p 0.001; Me -55.83%, Q1Q3: -67.80-40.29%, p 0.001). The dependence of the quality of life of patients on the prevalence of the skin process was noted (p 0.001). There was a statistically significant relationship between the activity of the skin process and the S100 protein in the blood serum of patients with vitiligo. (p 0.05) In addition, the analysis of the dynamics of immunological parameters of the main group compared with the control group showed a more significant decrease in the level of cytokines, as well as S100 protein in blood serum (p 0.001).
 CONCLUSION: The combination of azathioprine and NB-UVB is effective and safe, helps to stabilize the skin process and stimulate the repigmentation of foci, significantly improving the quality of life of patients, contributes to the normalization of immunological parameters, leading to an earlier stop of the progression of the skin process.