Use Of Dapsone Research Articles

Major aphthous ulcers in patients with HIV disease

Major aphthous ulcers are associated with a high degree of morbidity in patients infected with human immunodeficiency virus. A large representative cohort intected with human immunodeficiency virus was examined to evaluate the prevalence of major aphthous ulcers, demographic data of patients with major aphthous ulcers, and the usage of major aphthous ulcers as a marker for immune deterioration. The effects of tobacco smoking and the use of specific antibiotics, trimethoprim/sulfamethoxalazole or dapsone, on the development of major aphthous ulcers was also investigated. In a population of 767 persons infected with human immunodeficiency virus, major aphthous ulcers were found at a prevalence rate of 3.1% (24 patients). This type of lesion did not show any predilection for human immunodeficiency virus transmission category, ethnic group, or gender. Persons who received trimethoprim/sulfamethoxalazole or dapsone or had a history of tobacco smoking showed a decreased prevalence of major aphthous ulcers. All patients (100%) with major aphthous ulcers had CD4+ cell counts below 100 cells/mm 3, but only 50% had a previous acquired immunodeficiency syndrome defining illness. Major aphthous ulcers in persons infected with human immunodeficiency virus are suggestive of severe immune suppression and may serve as a marker for human immunodeficiency virus disease progression.

Maloprlm-Induced Pulmonary Eosinophilia

A 47-year-old woman developed pulmonary eosinophilia from the use of maloprim as malaria prophylaxis. The diagnosis was confirmed by bronchoalveolar lavage (BAL) and transbronchial lung biopsy. Her condition improved with drug withdrawal and steroid therapy. With the increased use of pyrimethamine and dapsone in the treatment of human immunodeficiency syndrome (HIV) infection, this form of drug allergy may become more common.

Counteracting effects of oral dapsone use

Counteracting effects of oral dapsone use

Treatment and management of dermatitis herpetiformis

The first documented use of sulfonamides for the treatment of dermatitis herpetiformis (DH) was by Costello in 1940 (1). He recorded that the rash of DH cleared within days of starting treatment with sulfapyridine. The rationale for this that DH was caused by bacterial allergy was subsequently proved erroneous. Nevertheless, the observation allowed for empiric treatment of the rash with drugs that are still used today though the mechanism of their therapeutic action remains unclear. The use of dapsone (diaminodiphenyl sulfone) for the management of DH was reported first by Esteves and Brando (2). Since these early observations, the use of these drugs for the treatment of DH has become well established, and their effectiveness is such that the therapeutic response to dapsone was used as a diagnostic test for the disease until the advent of immunofluorescence in the early 1970s. The next milestone in the therapy and management of DH came in 1966 when Marks and her colleagues demonstrated an enteropathy in 9 of 12 patients with DH (3). In the following year, Fry and colleagues pointed out the similarity between the enteropathy found in patients with DH and that of celiac disease (4). Further studies by these authors showed that both the enteropathy and the rash were gluten dependent, thereby indicating that DH was caused by an extrinsic antigen and was distinct from other bullous diseases (5,6). The efficacy of a gluten-free diet (GFD) has now been established by other centers (710) but it must be adhered to strictly to be effective and even then it takes an average of 28 months for the rash to be controlled by diet alone.

Lymphocyte activation and phospholipid pathways. 31P magnetic resonance studies

31P NMR spectra of perfused lymphocytes, embedded in alginate capsules and activated by interleukin-2, were remarkably different from those of control lymphocytes. The main differences were the appearance and gradual increase in phosphodiester signals, glycerophosphocholine and glycerophosphoethanolamine. These metabolic changes also occurred following perfusion with phorbol ester and after incubation with phytohemagglutinin (PHA) and were not dependent on a special growth medium. Nifedipine, a calcium channel blocking drug, inhibited the effects of phytohemagglutinin, but not of interleukin-2. There were no NMR spectral differences between peripheral lymphocytes, stimulated for 3 weeks, and tumor-infiltrating lymphocytes. Thus, sustained accelerated turnover of phosphatidylcholine and phosphatidylethanolamine is an inherent feature of the activation process. 31P NMR spectra of lymphocytes are characterized by a low signal of phosphocholine. Perfusion studies with high concentrations of choline and the use of dapsone, an inhibitor of cytidylyltransferase, indicated that choline kinase plays a key role in regulating phosphaditylcholine synthesis in human lymphocytes.

The Incidence of Agranulocytosis During Treatment of Dermatitis Herpetiformis With Dapsone as Reported in Sweden, 1972 Through 1988

During the 17-year period 1972 through 1988, a total of seven cases of agranulocytosis associated with the use of dapsone for the treatment of dermatitis herpetiformis were reported in Sweden. The median age of the patients involved was 61 years; three of them were male. The median duration of dapsone treatment was 7 weeks and the daily prescribed dose was 100 mg. Based on sales and prescription data, the crude relative risk of agranulocytosis during dapsone treatment of dermatitis herpetiformis was 50, and the total risk was one case per 3000 patient years of exposure to dapsone. In relation to the number of new cases of dermatitis herpetiformis, agranulocytosis was estimated to develop in 1 of 240 to 425 patients receiving dapsone therapy. Patients should be instructed to seek medical care immediately in case of fever.

Disseminated pustular dermatosis in polycythemia vera: Relationship with neutrophilic dermatosis of myeloproliferative disorders: Study of neutrophil function

An unusual case of disseminated pustular eruption associated with polycythemia vera is described. This eruption can be included in the group of neutrophilic dermatoses of myeloproliferative disorders (pyoderma gangrenosum, Sweet's syndrome). A defect in superoxide anion (O2-) generation is detected. The fact that both the clinical condition and the neutrophil function improved with the use of dapsone suggests that the O2- generation defect may play a role in the pathogenesis of the eruption. From an evolutionary standpoint, the occurrence of a neutrophilic dermatosis in polycythemia vera could be an unfavorable sign of preleukemia.

Brown Recluse Spider Bites: Stay Cool

To the Editor.— The recommended therapy for brown recluse (BR) spider bites in the southeastern United States remains controversial.1Because many bites are unremarkable,2some authors recommend no treatment. Intralesional or systemic corticosteroids with or without concurrent antibiotics have been used to treat BR bites.2,3Many surgeons prefer early surgical excision of serious bites.3We also found that BR bites are often unremarkable and heal without incident. Our findings in 31 patients with severe BR bites treated with either immediate surgical excision or dapsone1and delayed surgical excision, if required, were unequivocal. Immediate surgical excision of BR bite sites resulted in more complications than did the use of dapsone with or without delayed excision or repair. When the historical and clinical data from these patients with BR bites1,4were collected, we found the following: (1) Heat was commonly being recommended as adjunctive therapy for

Methemoglobinemia from dapsone therapy for a suspected brown spider bite

Recent reports have suggested the use of dapsone for brown spider bites. This drug, for many years restricted to use in cases of leprosy and rare dermatologic disorders, has significant side effects that must be recognized. A case of methemoglobinemis is reported in one such patient treated with dapsone. The difficulty of making the diagnosis of brown spider bite is discussed.

Treatment of cicatricial (benign mucous membrane) pemphigoid with dapsone

Treatment of cicatricial pemphigoid is a problem because patients afflicted are elderly, the disease is chronic, systemic agents required for control are potentially toxic (particularly to older patients), and the disease is often in an advanced stage when the diagnosis is established and requires aggressive therapy for control. We selected dapsone as an alternative anti-inflammatory agent because it has provided control in a subset of patients with bullous pemphigoid, five of six who had oral lesions. Twenty-four patients with cicatricial pemphigoid were treated with dapsone. Twenty (83.3%) had partial or complete control with mild to no inflammatory activity. Control was obtained within 4 weeks in eleven of the twenty patients. The use of dapsone was discontinued in two patients because it failed to control their disease and in four patients (two with control) because of drug-related side effects. Cicatricial pemphigoid may be added to the list of dapsone-responsive dermatoses.

Autosomal Recessive Prolidase Deficiency

Three patients had prolidase deficiencies. The family pedigree of these three patients suggests that this rare disorder is inherited through an autosomal recessive gene. this genodermatosis is characterized by a number of signs and symptoms referable to the skin, CNS, teeth, ears, nose, throat, eyes, bones, and joints. Among the skin changes, recalcitrant leg ulcers are the most characteristic. At this time, there is no established method of treatment of this rare disorder, but the use of dapsone was helpful in the treatment of one of our patients.

Varying distribution of acetylation phenotypes in RA patients with and without Sjögren's syndrome.

The acetylator phenotype status was studied in 61 patients with rheumatoid arthritis (RA), of whom 27 had associated Sjögren's syndrome (SS). The acetylation tests were carried out by means of isoniazid and in 24 patients also with the use of dapsone; there was complete agreement between the outcome of the two tests. The results showed that the frequency of slow acetylators in the whole material was 59%. In RA patients with SS, however, the frequency of slow acetylators was as great as 78%, while it was only 44% among patients without SS (p less than 0.02). Thus, there appears to exist a (pharmaco) genetic difference between RA patients with and without SS. In addition, toxicodermias were found to be more frequent in RA patients with than without SS (P less than 0.01). However, this could not be systematically correlated to slow acetylation.

Dapsone-Induced Hemolytic Anemia in a Patient with Relapsing Polychondritis

A 53-year-old woman presented with bilateral auricular chondritis which was responsive to high doses of prednisone. After a diagnosis of relapsing polychondritis was confirmed, she was treated with dapsone. Her disease responded well to dapsone 200 mg daily. While on this regimen, she developed a dapsone-induced hemolytic anemia which was successfully managed by a reduction in dosage. The use of dapsone for relapsing polychondritis and dapsone-induced hemolytic anemia are reviewed.

Dapsone-Induced Jaundice

Enthusiasm in the use of dapsome for acne conglobata and other severe acne has created an increase in the use of this drug by dermatologists. We describe three patients in whom jaundice developed during dapsome therapy of 3 to 36 weeks' duration. Jaundice was due to cholestasis in two cases and to hemolysis in the third. These significant side effects call for careful observation by the physician if dapsone is to be used with safety.

The oxidative effects of a dapson derivative on normal and chronic granulomatous disease polymorphonuclear function

To evaluate the potential use of dapsone (4-diaminodiphenyl sulfone), to restore oxidative metabolism and bactericidal potency to polymorphonuclear (PMN) leukocytes from patients with chronic granulomatous disease (CGD), the active derivative of dapsone, 4-amino-4′-hydroxylaminodiphenyl sulfone (DDS-NOH) was evaluated for its ability to generate reduced products of oxygen. In a cell free system, DDS-NOH reduced the redox dye, nitroblue tetrazolium (NBT) and the reaction was ablated by superoxide dismutase (SOD), an enzyme specific for inhibiting superoxide anion mediated reactions. Addition of catalase, a scavenger of hydrogen peroxide (H2O2), and sodium benzoate or mannitol, both scavengers of hydroxyl radical, had no effect on the reduction of NBT by DDS-NOH. In an acellular system, high concentrations of DDS-NOH were bactericidal forStaphylococcus aureus 502A and the effect was enhanced by SOD. Catalase, but not benzoate or the singlet oxygen scavenger, beta carotene, eliminated the bactericidal effect of DDS-NOH in the presence of SOD. Incubation of CGD PMNs with 0.2 and 1.0mM DDS-NOH for 30 minutes improved the rate of glucose-1-14C oxidation and the rate of iodination of ingested zymosan particles to activities observed in control leukocytes. However, the bactericidal response was only partially restored. Washed leukocytes previously incubated with DDS-NOH failed to show enhancement of bactericidal activity in CGD PMN supporting the idea that DDS-NOH does not enter the cell. Exposure of normal and CGD PMN to 0.02mM DDS-NOH promoted capping of Concanavalin A (Con A) on the plasma membrane and improved the translocation of the granular enzyme, myeloperoxidase into phagocytic vesicles. Both responses depend upon the disassembly of cytoplasmic microtubules confirmed directly by3H colchicine binding. These studies indicate that DDS-NOH generates superoxide anion and H2O2 which are bactericidal but the oxidative properties of DDS-NOH are toxic toward the sulfhydryl containing microtubules allowing only partial restoration of CGD PMN phagocytic function.