Title

6-MERCAPTOPURINE FOR SEVERE ATOPIC DERMATITIS INA LACTOSE-ALLERGIC CHILD

Document Type

Poster

Publication Date

6-16-2017

Published In / Presented At

13th World Congress of Pediatric Dermatology, Chicago, IL, July 6–9, 2017

Disciplines

Dermatology

Abstract

6-MERCAPTOPURINE FOR SEVERE ATOPIC DERMATITIS IN A LACTOSE-ALLERGIC CHILD Pediatric atopic dermatitis (AD) is encountered routinely in the gen- eral dermatology clinic, and most children with AD have readily- manageable mild to moderate disease. For severe AD that is resis- tant to topical corticosteroids and calcineurin inhibitors, the use of several steroid-sparing agents has been described in the literature, including cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine. Herein we report what is to our knowledge the first use of 6-mercaptopurine (6MP) for pediatric AD. The patient was a 13-year-old boy with a long-standing history of severe atopic dermatitis. Previous treatments with topical corticos- teroids and heavy emollients were unsuccessful. The patient’s med- ical history was complicated by persistent asthma, food allergies, massively elevated IgE, and adrenal insufficiency related to chronic use of inhaled corticosteroids. Azathioprine and omalizumab were the main considerations for long term steroid-sparing agents, how- ever it was ultimately decided that the IgE levels were too high to safely proceed with omalizumab. Given his numerous food aller- gies, the composition of commercially available azathioprine was carefully reviewed and all were found to contain lactose. However, 6MP was determined not to contain lactose and was initiated. 6MP is the active metabolite of azathioprine. While originally approved for the induction and maintenance of acute lymphoblastic leukemia, 6MP has also been used for Crohns disease and ulcera- tive colitis. We followed the previously published dosing protocols for pediatric Crohns disease after checking baseline labwork, including thiopurine methyltransferase enzyme activity. The patient has tolerated the 6MP well and has maintained a significant reduc- tion of AD severity after an initial course of cyclosporine. This is therefore the first documented case of using 6MP as a lac- tose-free steroid sparing agent for the treatment of severe pediatric AD.

Comments

POSTER ABSTRACTS NOT ACCEPTED FOR LIVE PRESENTATION Acne & Related Skin Disorders