Methotrexate and azathioprine for the treatment of atopic eczema

Patients with severe atopic eczema may require prolonged treatment with large amounts of highly potent topical corticosteroids and/or systemic treatment. Cyclosporin and systemic corticosteroids have proven to be effective, but a number of patients have to discontinue this treatment due to ineffectiveness or side effects. Disease-modifying, anti-rheumatic drugs such as methotrexate and azathioprine are alternative therapeutic options, but evidence regarding their effectiveness is lacking.

In a study published in the April 2011 issue of The Journal of Allergy and Clinical Immunology (JACI), Schram et al show results of the first head-to-head comparison of azathioprine versus methotrexate for the treatment of patients with severe atopic eczema. The researchers used a variety of measures, including the SCORAD (SCORing Atopic Dermatitis) system, to assess the severity of the patients’ condition. When they were assessed at week 12, patients in the methotrexate group (n=20) experienced a statistically significant improvement in SCORAD score of 42%, versus 39% improvement in the azathioprine group (n=22).

Overall, neither the SCORAD assessment, nor any of the other measures used by the researchers, revealed a statistical difference between the two treatments, either at week 12 or at week 24. The number and severity of adverse events were generally similar in short-term treatment.

The authors conclude that both methotrexate and azathioprine are effective and safe short-term treatment options for adult patients with severe atopic eczema. The results from this study justify treatment with these drugs when routine treatment is insufficient. Long-term follow-up of these patients is necessary to gather additional information.


The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

AAAAI - American Academy of Allergy Asthma & Immunology