thioguanine-anhydrous and Skin-Diseases

Cytotoxic and immunosuppressive drugs are regularly used to treat proliferative, immunologically mediated inflammatory disorders and some neoplastic diseases of the skin. Methotrexate, azathioprine, mycophenolate mofetil, cyclosporin cyclophosphamide, chlorambucil, and other related drugs have potential benefits in the treatment of severe and/or recalcitrant rheumatic skin diseases. The therapeutic window for these agents is narrow. The major uses of these drugs are for life-threatening cutaneous disorders or as steroid-sparing agents.

Topics: Adult; Alkylating Agents; Antimetabolites; Azathioprine; Child; Chlorambucil; Cladribine; Cyclophosphamide; Cyclosporine; Drug Interactions; Female; Humans; Immunosuppressive Agents; Methotrexate; Mycophenolic Acid; Pregnancy; Pregnancy Complications; Rheumatic Diseases; Skin Diseases; Thioguanine

The use of immunosuppressive agents in dermatology has increased widely. The role of these medications has become increasingly important for the treatment of dermatologic disorders in an inpatient setting, where there is frequently a requirement for highly potent, fast-acting, effective agents. This article presents an overview of the general application, mechanisms of action, metabolism, and adverse effects commonly associated with systemic immunosuppressive agents used in dermatology.

Topics: Azathioprine; Chlorambucil; Cyclosporine; Humans; Immunosuppressive Agents; Methotrexate; Mycophenolic Acid; Skin Diseases; Tacrolimus; Thioguanine

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

Topics: Abnormalities, Drug-Induced; Adult; Aged; Azathioprine; Bone Marrow Diseases; Chemical and Drug Induced Liver Injury; Child; Cost-Benefit Analysis; Drug Administration Schedule; Drug Approval; Drug Costs; Drug Hypersensitivity; Drug Interactions; Female; Genetic Testing; Humans; Immunosuppressive Agents; Infections; Kidney Diseases; Lactation; Male; Methyltransferases; Nausea; Neoplasms; Off-Label Use; Patient Education as Topic; Pregnancy; Risk Factors; Skin Diseases; Thioguanine; Virus Diseases

6-thioguanine, an antimetabolite not potentiated by allopurinol, has been used in the treatment of 29 patients with polycythemia vera. All but two of the patients had been treated previously by venesection and/or radioactive phosphorus (32p) and/or alkylating agents. The usual dose was 40-160 mg daily alternate weeks according to individual response. The treatment period varied from 6-66 months (mean, 31 months). Of 27 evaluable patients 24 (89%) responded to treatment and at one year there was a significant fall in all blood count parameters. Seven patients relapsed while on treatment and four were withdrawn because of side effects. 6-thioguanine merits further evaluation in the management of polycythemia vera, particularly in those patients who have received large cumulative doses of 32p and/or alkylating agents and in whom an alternative mode of therapy is desirable.

Topics: Aged; Blood Cell Count; Drug Administration Schedule; Drug Evaluation; Hematocrit; Humans; Male; Middle Aged; Nausea; Patient Compliance; Polycythemia Vera; Recurrence; Skin Diseases; Thioguanine