mercaptopurine and Skin-Diseases

Topics: Azathioprine; Counseling; Humans; Mercaptopurine; Methylation; Methyltransferases; Skin Diseases; Skin Diseases, Vesiculobullous

Topics: Alleles; Azathioprine; Erythrocytes; Heterozygote; Homozygote; Humans; Mercaptopurine; Methyltransferases; Polymorphism, Genetic; Skin Diseases

Topics: Adolescent; Adult; Crohn Disease; Fistula; Gastric Fistula; Humans; Intestinal Fistula; Mercaptopurine; Middle Aged; Parenteral Nutrition; Skin Diseases

Topics: Adrenal Cortex Hormones; Autoimmune Diseases; Azathioprine; Chlorambucil; Cyclophosphamide; Drug Therapy, Combination; Folic Acid Antagonists; Histamine H1 Antagonists; Humans; Immunosuppression Therapy; Mercaptopurine; Salicylates; Skin; Skin Diseases

Topics: Animals; Antineoplastic Agents; Azathioprine; Azauridine; Bleomycin; Chlorambucil; Cyclophosphamide; Cytarabine; Dactinomycin; Humans; Hydroxyurea; Immunosuppressive Agents; Mercaptopurine; Methotrexate; Procarbazine; Skin Diseases; Skin Neoplasms; Vinblastine; Vincristine

Topics: Adrenal Cortex Hormones; Animals; Antibody Formation; Autoimmune Diseases; Azathioprine; Cyclophosphamide; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Pemphigus; Skin Diseases

Topics: Antimetabolites; Clinical Trials as Topic; Cortisone; Dermatomyositis; Humans; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Mercaptopurine; Polyarteritis Nodosa; Scleroderma, Systemic; Skin Diseases

Mercaptopurine is a crucial component in the treatment of acute lymphoblastic leukemia. It is associated with toxicities that can delay treatment. Mercaptopurine is metabolized into 6-thioguanine nucleotides and 6-methylomercaptopurine nucleotides (6MMPN). Accumulation of 6MMPN has previously been associated with hepatotoxicity, pancreatitis, and hypoglycemia. However, skin toxicity has rarely been reported. We report 5 cases of elevated 6MMPN levels associated with cutaneous manifestations.

Topics: Antimetabolites, Antineoplastic; Child; Humans; Mercaptopurine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Skin Diseases; Thioguanine

This study aimed to investigate whether there was a correlation between the genotype or haplotype of the methylenetetrahydrofolate reductase gene (MTHFR) and toxicities during consolidation therapy or plasma methotrexate (MTX) levels at 48 h after the first dose of MTX infusion. We retrospectively genotyped 181 children with newly diagnosed acute lymphoblastic leukemia (ALL) who were treated with the Chinese Children's Leukemia Group protocol. In standard- and medium-risk treatment branches, the 677T carriers (CT + TT) had a higher risk of developing thrombocytopenia when compared with carriers of the CC genotype (odds ratio [OR] 5.21, 95% confidence interval [CI] 1.18-23.01, p = 0.017). The 1298AC/CC genotypes were associated with a decrease in skin toxicity, as compared with the common AA genotype (p = 0.037). An estimation of haplotype frequencies showed that there was no 677T-1298C haplotype in the population. A lower frequency of anemia (OR 0.44, 95% CI 0.21-0.90, p = 0.025) and lower MTX level (p = 0.044) were observed in patients with the 677C-1298C haplotype than in those without. High plasma MTX level was correlated with anemia (p = 0.011) and neutropenia (p = 0.044). In the high-risk group, the polymorphisms or plasma MTX levels were not correlated with any toxicity. Taken together, our data demonstrate that genotyping of MTHFR and measurement of plasma MTX levels might be useful to optimize MTX therapy.

Topics: Adolescent; Antineoplastic Combined Chemotherapy Protocols; Asian People; Child; Child, Preschool; China; Drug-Related Side Effects and Adverse Reactions; Female; Gene Frequency; Genotype; Haplotypes; Humans; Infant; Linkage Disequilibrium; Logistic Models; Male; Mercaptopurine; Methotrexate; Methylenetetrahydrofolate Reductase (NADPH2); Neutropenia; Polymorphism, Single Nucleotide; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Skin Diseases; Thrombocytopenia

Juvenile xanthogranuloma (JXG), one of the most common forms of Langerhans-dendritic cell proliferation in young children, usually presents as spontaneously regressing cutaneous lesions. JXG with systemic (extracutaneous) involvement is a rare histiocytic disorder in which significant morbidity and death may occur. The systemic type, especially combined with multiple central nervous system lesions in young children, has a very poor prognosis. The patient described here presented with disseminated disease including lungs, liver, kidneys, ribs, scalp, and central nervous system. The patient was treated with multiagent chemotherapy based on the Langerhans cell histiocytosis II treatment protocol. The regimen used included an additional intrathecal therapy with methotrexate and prednisolone to control central nervous system lesions. The patient was treated for 28 months and has been in remission for almost 5 years.

Topics: Central Nervous System Diseases; Combined Modality Therapy; Craniotomy; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant; Injections, Spinal; Liver Diseases; Lung Diseases; Mercaptopurine; Methotrexate; Paresis; Prednisolone; Skin Diseases; Vinblastine; Xanthogranuloma, Juvenile

Azathioprine is employed for its immunosuppressive properties, as a steroid-sparing agent or as monotherapy. Its most traditional clinical indications are connective tissue diseases, vasculitis, post-transplant, and immunobullous dermatoses. The main disadvantages of azathioprine therapy are a delayed onset of action (6-8 weeks), and rare profound bone marrow toxicity. Susceptibility to bone marrow toxicity is due to a genetically determined metabolic defect (1 in 300). Patients at risk of such toxicity may be identified by a Thiopurine methyltransferase enzyme assay. We have undertaken a retrospective study, looking at the use of azathioprine as monotherapy for non-bullous inflammatory dermatoses. We studied a total of 24 patients (10 male, 14 female). The dermatoses comprised: atopic eczema (10), pompholyx (6), plaque psoriasis (6), and chronic actinic dermatitis (2). All patients had severe refractory disease warranting systemic second line therapy. The mean age was 49.4 years (range 17-86 years). The starting dose of azathioprine was 100-150 mg/day, and the maintenance dose 50-100 mg/day. The mean duration of treatment was 33.5 months(range 1-132 months). Eighteen patients (75%) showed a good to excellent sustained clinical response to azathioprine. This response rate was evenly represented in the 4 dermatoses studied. The adverse reactions encountered were raised MCV (6), leucopenia (2), raised hepatic enzymes (6), and dyspepsia (4). Azathioprine had to be discontinued due to adverse reactions in 2 patients (dyspepsia, raised hepatic enzymes) followed by normalization. Other factors that potentially contributed to the observed adverse events were present in 5 patients: alcoholism (2), erythromycin toxicity (1), and malabsorption (2). Our study demonstrates the efficacy of azathioprine monotherapy for severe atopic eczema, pompholyx, plaque psoriasis, and chronic actinic dermatitis. Furthermore, azathioprine is a low cost and generally well tolerated drug.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Azathioprine; Eczema; Eczema, Dyshidrotic; Female; Humans; Immunosuppressive Agents; Male; Mercaptopurine; Middle Aged; Retrospective Studies; Skin Diseases

Sixteen episodes of a distinctive, papular rash occurred in eight patients following withdrawal of 6-mercaptopurine (6MP) and methotrexate (MTX) used as maintenance therapy for acute lymphoblastic leukemia (ALL). The rash also developed in one of the eight patients when only 6MP was discontinued. The eruption occurred mainly on the face, and in this site resembled the perioral dermatitis seen following withdrawal of topical fluorinated steroids. The rash generally began within 3 weeks of stopping 6MP and lasted 3 to 4 weeks. It failed to improve with the use of topical corticosteroid. We conclude that this rash is caused by the withdrawal of oral 6MP.

Topics: Child; Face; Female; Humans; Leukemia, Lymphoid; Male; Mercaptopurine; Skin Diseases; Substance Withdrawal Syndrome

Many studies have shown that human skin in organ cultures containing pemphigus antibody undergoes acantholysis, the histologic hallmark of pemphigus vulgaris. This in vitro organ culture system provides a good model to determine if drugs used to treat pemphigus inhibit the effect of pemphigus antibody after it is produced. In this study we determined if hydrocortisone, dapsone, and 6-mercaptopurine (6-MP) could inhibit acantholysis observed in human skin organ cultures containing high constant levels of pemphigus plasma. In six experiments we demonstrated that hydrocortisone (10(-3) and 5 X 10(-4) M) present at the start of organ culture inhibited acantholysis induced by pemphigus sera. Thus, this study raises the possibility that the large doses of steroids used to treat acute pemphigus could act directly on the skin, inhibiting acantholysis in the presence of high titers of pemphigus antibody. Other effective immunosuppressive drugs, such as dapsone and 6-MP, probably do not act directly on the skin.

Topics: Acantholysis; Autoantibodies; Dapsone; Humans; Hydrocortisone; Mercaptopurine; Organ Culture Techniques; Pemphigus; Skin Diseases

Topics: Brain Neoplasms; Child; Child, Preschool; Cyclophosphamide; Cystitis; Drug Therapy, Combination; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Infant; Infections; Leukemia; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Pneumonia, Viral; Prednisone; Remission, Spontaneous; Skin Diseases; Vincristine; Viral Vaccines; Virus Diseases

Topics: Adrenal Cortex Hormones; Alkylating Agents; Animals; Anti-Inflammatory Agents; Capillaries; Cyclophosphamide; Disease Models, Animal; Female; Folic Acid Antagonists; Immunosuppressive Agents; Male; Mercaptopurine; Mice; Mice, Inbred Strains; Purines; Skin Diseases; Vasodilator Agents

Topics: Antineoplastic Agents; Azathioprine; Chlorambucil; Cyclophosphamide; Hair; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Melphalan; Mercaptopurine; Methotrexate; Neoplasms; Scleroderma, Systemic; Skin Diseases; Vinblastine

Topics: Adrenocorticotropic Hormone; Adult; Antimetabolites; Coal Tar; Dermatitis, Exfoliative; Glucocorticoids; Humans; Hydrocortisone; Male; Mercaptopurine; Methotrexate; Mouth Diseases; Oral Manifestations; Prednisolone; Psoriasis; Sepsis; Skin Diseases; Ulcer

Topics: Antineoplastic Agents; Azathioprine; Condylomata Acuminata; Fluorouracil; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mercaptopurine; Methotrexate; Papilloma; Pemphigus; Precancerous Conditions; Psoriasis; Scleroderma, Systemic; Skin Diseases; Skin Neoplasms; Virus Diseases

Topics: Dermatomyositis; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Mercaptopurine; Pemphigus; Scleroderma, Systemic; Skin Diseases