Oral Dapsone Research Articles

Dapsone for acne: Still in use after half a century!

Sixty years ago, Ross discussed the use of oral dapsone in the treatment of acne vulgaris. Ross was fundamental in demonstrating the importance of this medication in dermatology. Following this, topical formulations have been used for the treatment of acne vulgaris which has not responded to traditional therapies. We explore the impact that the discovery of dapsone has had on subsequent research and clinical practice and explore the typical doses and side effects of this often sidelined therapy. We conducted a review of the literature on the use of dapsone for acne using key terms "acne vulgaris," "dapsone," "isotretinoin," "systemic," "topical" searching databases such as MEDLINE, EMBASE, and PubMed. Only articles in English were chosen. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. Oral dapsone and topical dapsone have been used in acne vulgaris and acne fulminans. Systemic dapsone seems to be less effective than other treatment options, and further research is required to examine the use of the topical formulation for acne vulgaris compared with alternative treatments. Dermatologists may wish to consider the use of this long-established medication for the treatment of acne vulgaris. With careful monitoring, oral dapsone is an important alternative therapy where isotretinoin is contraindicated or not tolerated.

Case Report of Treatment Resistant Pyoderma Gangrenosum

This is a case of a 38-year-old married female diagnosed with Pyoderma Gangrenosum (PG) for 4 years. This patient was very anxious and frustrated. The patient was using all the standard treatments for PG, oral steroids 40mg/day, colchicine 2mg/day, topically tacrolimus 0.1%, topically metronidazole, oral 3rd generation of cephalosporin antibiotics 1gm/day, and oral dapsone 100mg/day but lesion was getting worse. The patient family and her husband were very supportive and all the negative options of physical and mental abuse, and not taking proper medicine have been completely ruled out by taking a detailed history from the patient alone. The patient is willing to get the cure and take and apply for all the medicines properly. All the other diseases have been ruled out that can be associated with PG such as inflammatory bowel diseases, trauma, vasculitis, arthritis, etc. The patient has been to many physicians but has not been able to get better and the lesion is getting worse day by day and because of this patient started the symptoms of depression and start losing weight. PG is a very worrisome disease and usually, PG cure rate is unpredictable. Patients having PG have emotional problems too because of lesions. The patient usually isolates herself from society and lost all her confidence.

Thumb Ulcer Presenting As Soft Tissue Infection in a Patient With Sweet’s Syndrome Intolerant To Systemic Corticosteroids: A Case Report

Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, is an uncommon dermatological condition characterized by sudden onset, painful, erythematous/violaceous papules, plaques and ulcers, and specific histopathologic findings. Ulcers commonly present on the trunk, neck, hands and typically respond to systemic corticosteroid treatment. Here, we present a case of a 63-year-old woman with Sweet’s syndrome that presented with a thumb ulcer resembling a soft tissue infection. The thumb lesion was refractory to management for an infection and tissue pathology was consistent with a Sweet’s lesion. The patient was intolerant to first line therapy of oral prednisone, but the lesion was initially responsive to topical clobetasol and maintenance therapy of oral dapsone. This case emphasizes the importance of a careful history, examination, workup and maintaining a broad differential diagnosis to prevent misdiagnosis. We also demonstrate the potential effectiveness of initial topical treatment for problematic Sweet’s lesions when systemic steroids are contraindicated.

15607 Dapsone to treat moderate to severe hidradenitis suppurativa: A retrospective case-series

Background: Management of hidradenitis suppurativa (HS) is challenging since no single treatment provides consistently effective results, leaving patients with frequent relapses. Dapsone, a sulfonamide drug, combines antimicrobial and antiinflammatory properties that address aspects of HS pathogenesis. Few studies have evaluated the efficacy of oral dapsone on HS, especially in severe disease.

Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated.
 Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks.
 Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile.
 Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

Erosive pustular dermatosis of the scalp: causes and treatments.

Erosive pustular dermatosis of the scalp is a rare condition which primarily affects older women after local trauma and has historically been treated with topical steroids. As it is a rare entity and resembles other dermatologic conditions, it may easily be misdiagnosed. Identifying the causes and evaluating the efficacy of treatments of erosive pustular dermatosis of the scalp (EPDS) is of great importance to both avoid misdiagnosis and ensure optimal treatment of this rare condition. There are numerous causes. In addition to surgeries and physical injuries, topical and procedural treatments for actinic keratoses and androgenetic alopecia can trigger the development of lesions. There are also documented associations with several autoimmune and systemic conditions. Besides corticosteroids, topical tacrolimus and photodynamic therapy were the most commonly used treatments for EPDS. They were effective with few recurrences and adverse effects. Other successful treatment options were topical dapsone, silicone gels, calcipotriol, acitretin, and isotretinoin. Oral dapsone can be used in cases of disseminated disease. Zinc sulfate should be considered with low-serum zinc levels. While cyclosporine was effective, there were adverse effects that may limit its use. It is important for dermatologists to be aware of the wide array of potential causes of erosive pustular dermatosis and include it on their differential. Additionally, although high-potency topical steroids have been historically used as the first-line treatment, there are many other effective treatments that may avoid recurrence and skin atrophy, particularly in the elderly population.

Behcet disease - A nonvenereal cause of genital ulceration

Behcet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no diagnostic or pathognomonic test. Here, we present a case of 26-year-old male with a complaint of recurrent oral, genital, and cutaneous lesions. The diagnosis of BD was confirmed on the basis of revised the International Criteria for BD. The case was treated satisfactorily with systemic corticosteroid in the tapering dose and oral Dapsone.

IgA pemphigus: A systematic review

Theclinical, histologic, and immunopathologic features of IgA pemphigus have not been studied on a large scale. To synthesize existing data on the epidemiologic, clinical, histologic, and immunologic features of IgA pemphigus. We performed a systematic review using MEDLINE, Embase, and Web of Science databases. Case reports and series of patients with IgA pemphigus were included. A total of 119 eligible studies, comprising 137 patients with IgA pemphigus with a mean age of 51.5±21.0years, were included. Most patients presented with vesicles (80.8%), pustules (75.0%), and circinate plaques (63.6%). Pruritus was present in 65.6% of reported patients. Intercellular deposition of IgA was noted in almost all patients (97.0%), and the remaining 3.0% of patients had IgA positivity on indirect immunofluorescence or enzyme-linked immunosorbent assay confirming the diagnosis. IgA circulating intercellular antibodies were detected in only 66.7% patients. IgA gammopathy and ulcerative colitis were associated with IgA pemphigus in 9.5% and 6.6% patients, respectively. Oral dapsone and corticosteroids were the mostly commonly used treatments. Results are mainly based on case reports and small case series. The diagnosis of IgA pemphigus may be considered in patients presenting with vesiculopustular eruption and circinate plaques with truncal and extremity involvement.

2065 A Rare Case of IgA Vasculitis Secondary to Infliximab Use in Crohn’s Disease

INTRODUCTION: The advent of Infliximab (IFX) has revolutionized the treatment for inflammatory bowel disease. Although the most common adverse effects include infusion site reactions and loss of response due to antibody formation, there have been some reports of secondary autoimmune conditions. Herein, we report a rare case of IgA vasculitis likely as a result of IFX therapy. CASE DESCRIPTION/METHODS: A 53-year-old female with known fistulizing ileocolonic Crohn's disease (CD) on IFX since 2002, multiple bowel surgeries for her CD, rheumatoid arthritis, and postoperative deep vein thrombosis, presented with a 2-week history of progressive petechial rash on her bilateral lower extremities (Figures 1 and 2). Skin biopsy of one of the lesions was notable for granular deposition of IgA consistent with IgA vasculitis. She was initiated on oral Prednisone 1 mg/kg/day. Three weeks later, she was transitioned to oral Dapsone with a slow prednisone taper. The next day, the patient developed abdominal pain with nausea and vomiting. CAT scan of the abdomen was notable for a large thrombus in the descending thoracic aorta. A thorough workup for small vessel vasculitis was undertaken which was negative with pertinent negative tests including ANCA, Cryoglobulin levels, Rheumatoid Factor, serum electrophoresis, protein C & S, Anti-thrombin 4 level, Anticardiolipin antibody, and Beta-2 glycoprotein level. She was treated with anticoagulation for the aortic thrombus with IV heparin and then later transitioned to oral Rivaroxaban. Repeat CAT scan a month later showed resolution of the clot in the aorta. Regarding the Crohn’s disease, a decision was made to switch her therapy from IFX to Ustekinumab for maintenance of remission. DISCUSSION: IgA mediated vasculitis is a rare adverse reaction which can be caused by anti-tumor necrosis factor (TNF) agents and remains poorly understood. It has been described with all the commonly used anti-TNF agents and usually occurs after several months of use. In our patient, this occurred after several years of use. None of the other medications on her list were noted to have an association with IgA mediated vasculitis. Clinical symptoms can range from local cutaneous manifestations to multi-system involvement. In our patient, skin and large vessel (aorta) were involved. The resolution of symptoms may be achieved by discontinuing use of the culprit anti-TNF agent and initiating adjuvant treatment. Alternative non-anti-TNF therapies should be pursued for definitive treatment.

Subcorneal pustular dermatosis treated with oral dapsone

Subcorneal pustular dermatosis treated with oral dapsone

Cutaneous lupus erythematosus: A review of the literature.

Knowledge with regard to the pathogenesis of lupus erythematosus has progressed rapidly over the past decade, and with it has come promising new agents for the treatment of cutaneous lupus erythematous (CLE). Classification of CLE is performed using clinical features and histopathologic findings, and is crucial for determining prognosis and choosing therapeutic options. Preventative therapy is critical in achieving optimal disease control, and patients should be counseled on sun-safe behavior and smoking cessation. First-line therapy includes topical corticosteroids and calcineurin inhibitors, with antimalarial therapy. Traditionally, refractory disease was treated with oral retinoids, dapsone, and other oral immunosuppressive drugs, but new therapies are emerging with improved side effect profiles and efficacy. Biologic agents, such as belimumab and ustekinumab, have been promising in case studies but will require larger trials to establish their role in routine therapy. Other novel therapies that have been trialed successfully include spleen tyrosine kinase inhibitors and fumaric acid esters. Finally, new evidence has been published recently that describes safer dosing regimens in thalidomide and lenalidomide, both effective medications for CLE. Given the chronic disease course of CLE, long-term treatment-related side effects must be minimized, and the introduction of new steroid-sparing agents is encouraging in this regard.

Sweet’s syndrome: A Therapeutic challenge

Sweet’s syndrome: A Therapeutic challenge - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.037, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Cutaneous Bullous Eruption Revealing Wells' Syndrome in a Child

Wells’ syndrome or eosinophilic cellulitis is a rare disease of which bullous form is uncommon, especially in children. We report a rare and original case of bullous Wells’ syndrome in a 10-year-old boy who was successfully treated with oral dapsone. It is therefore important to consider Wells’ syndrome in patients presenting recalcitrant bullous cutaneous eruption with eosinophilia.

Autoimmune blistering dermatoses in children

Autoimmune blistering skin disorders represent arare group of autoantibody-induced dermatoses against desmosomal and hemidesmosomal molecules. The common age of onset for pemphigus and pemphigoid, as well as dermatitis herpetiformis, encompasses the adult age, but all these disorders can be observed neonatally and/or during childhood. If the disease occurs postpartum or neonatally, physicians should consider transplacental transmission of pathogenic maternal immunoglobulin G (IgG)-autoantibodies, and both mother and child should be included in the diagnostic work up. If the disorder is suspected in childhood, early immunoserological testing and skin biopsies for direct immunofluorescence analyses are recommended for the correct diagnosis and subsequently for the right choice of treatment. First-line recommendations are nonhalogenated topical steroids, followed by oral dapsone. All therapies require preliminary examinations, e. g. enzyme-activity testing (as is glucose-6-phophate dehydrogenase in dapsone treatment). In refractory cases, further treatment choices like high-dose intravenous immunoglobins, plasmapheresis/immunoadsorption or targeted therapies like anti-CD20 autoantibody therapies are indicated. An intense dermatological support and good medical care are essential for an age-appropriate development of the child and to lower possible treatment-associated adverse events.

Rhinosporidiosis of the Lacrimal Sac

LEGEND A 23-year-old man presented with a recurrent painful lesion in the left lacrimal sac region since 1 year. Before presenting to the authors, he was diagnosed to have left lacrimal abscess and had a history of incision and drainage from the left lacrimal sac on 4 occasions and had also undergone excisional biopsy of the lesion with a suspicion of lacrimal sac tumor. Examination revealed a 2 × 2 cm firm mass in the left lacrimal sac region (Fig. A). Computed tomography of the orbit revealed a soft tissue lesion in the left lacrimal sac region (Fig. B). Paranasal sinuses were normal. Left dacryocystectomy was performed ensuring complete removal of the mass. Histopathology findings revealed a luminal wall lined by stratified squamous epithelium with a dense stromal infiltrate of lymphocytes, plasma cells, and eosinophils (Fig. C). Characteristic features of rhinosporidiosis were present. These included multiple large sporangial cysts filled with endospores and smaller thick-walled trophocytes with single central nuclei (Fig. D). The final diagnosis was rhinosporidiosis of the lacrimal sac, and the patient was treated with oral dapsone 100 mg once daily for 6 months to prevent the recurrence of the lesion. This case highlights the importance of histopathological examination to establish an accurate diagnosis and initiate appropriate treatment in a case of lacrimal sac pathology.Lacrimal sac rhinosporidiosis.

Ashy dermatosis: a review

Ashy dermatosis is characterized by asymptomatic, symmetrically-distributed, gray-colored macules located on the trunk, neck, face, and upper extremities. The condition occurs most commonly in patients with Fitzpatrick phototype III-V skin. The etiology is unknown, but drug ingestion, infection, and genetic factors have been suggested to elicit ashy dermatosis. No gold standard treatments have been established yet. The most successful treatment to date has been clofazimine, although topical tacrolimus, oral dapsone, narrowband ultraviolet light B phototherapy, and isotretinoin have shown treatment success. Ashy dermatosis is primarily a cosmetic concern, but can be a very distressing condition, especially for dark skinned individuals. Therefore, an increase in clinician awareness and more studies are needed to further understand the etiology and treatment options for this disease. This review serves as a single source for clinicians to stay up-to-date regarding the history, clinical presentation, histology, pathogenesis, differential diagnosis, and management options for ashy dermatosis. It also suggests an alternative name that more appropriately encompasses the clinical and histopathologic features, while acknowledging our lack of understanding of its etiology: macular hyperpigmentation of indeterminate etiology.

Consensus on the treatment of autoimmune bullous dermatoses: pemphigus vulgaris and pemphigus foliaceus - Brazilian Society of Dermatology.

Pemphigus are intraepidermal autoimmune bullous dermatoses that occur with lesions on the skin and / or mucous membranes. The most frequent types are pemphigus vulgaris and pemphigus foliaceus (classic and endemic). This consensus aims to present a complete and updated review of the treatment of these two more frequent forms of pemphigus, based on the literature and the personal experience of the authors. In moderate and severe cases of pemphigus vulgaris and foliaceus, systemic corticosteroid therapy (prednisone or prednisolone) is the treatment of choice. Adjuvant drugs, usually immunosuppressive drugs (azathioprine, mycophenolate mofetil, methotrexate, cyclophosphamide) may be prescribed as corticosteroid sparers in refractory cases or with contraindications to corticosteroids to minimize side effects. In severe and nonresponsive cases, corticosteroids in the form of intravenous pulse therapy, immunoglobulin and plasmapheresis / immunoadsorption can be administered. Immunobiological drugs, particularly rituximab, appear as a promising alternative. For milder cases, smaller doses of oral corticosteroid, dapsone and topical corticosteroids are options. At the end flowcharts are presented as suggestions for a therapeutic approach for patients with pemphigus vulgaris and pemphigus foliaceus.

Adjuvant treatment of severe/refractory bullous pemphigoid with protein A immunoadsorption.

While depletion of circulating autoantibodies using immunoadsorption (IA) is an established therapeutic approach in patients with pemphigus vulgaris, IA has only sporadically been used in other autoimmune bullous disorders. Although bullous pemphigoid (BP) usually responds well to topical and systemic corticosteroids, rapid depletion of serum autoantibodies may be an effective adjuvant treatment option in patients with severe and/or refractory disease. Case series of 20 patients (13 women, 7 men; mean age 78.6 years; range 56-94 years) with severe or refractory BP. In addition to oral prednisolone (0.25-0.5 mg/kg/day), dapsone (1.0-1.5mg/kg/day), and clobetasol propionate 0.05% ointment (lesional application, twice daily), treatment consisted of proteinA IA (three sessions on consecutive days). The mean follow-up period was 33.6 months (1-84 months). The majority of patients showed a rapid and sustained response. One month after treatment, eight patients (42%; 19 patients were included in the follow-up) were in complete remission; at the last follow-up visit (after 1 to 84 months), that number was 13 (68%). Not only was there an initial drop in anti-BP180 autoantibodies (by 92%), the effect also continued after one and three months, with mean autoantibody levels at 26% and 13% of baseline, respectively (p<0.001). Both previously treated and treatment-naive patients showed a significant reduction in anti-BP180NC16A antibody levels throughout the observation period. Adverse events occurred in 13 of the 20 patients (65%). Three were severe of which two were likely or probably related to IA. Immunoadsorption is an effective adjuvant treatment option for (the usually elderly) patients with severe and/or refractory BP.

Effectiveness of systemic treatments for pyoderma gangrenosum: a systematic review of observational studies and clinical trials.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis with substantial morbidity. There is no consensus on gold-standard treatments. To review the effectiveness of systemic therapy for PG. We searched six databases for 24 systemic therapies for PG. Primary outcomes were complete healing and clinical improvement; secondary outcomes were time to healing and adverse effects. We found 3326 citations and 375 articles underwent full-text review; 41 studies met the inclusion criteria. There were 704 participants in 26 retrospective cohort studies, three prospective cohort studies, seven case series, one case-control study, two open-label trials and two randomized controlled trials (RCTs). Systemic corticosteroids were the most studied (32 studies), followed by ciclosporin (21 studies), biologics (16 studies) and oral dapsone (11 studies). One RCT (STOP-GAP, n=121) showed that prednisolone and ciclosporin were similar: 15-20% of patients showed complete healing at 6weeks and 47% at 6months. Another RCT (n=30) found that infliximab was superior to placebo at 2weeks (46% vs. 6% response), with a 21% complete healing rate at 6weeks. Two uncontrolled trials showed 60% and 37% healing within 4months for canakinumab and infliximab, respectively; other data suggest that patients with concurrent inflammatory bowel disease may benefit from biologics. The remaining studies were poor quality and had small sample sizes but supported the use of corticosteroids, ciclosporin and biologics. Systemic corticosteroids, ciclosporin, infliximab and canakinumab had the most evidence in treating PG. However, current literature is limited to small and lower-quality studies with substantial heterogeneity.

IgA Pemphigus in a Child – a Case Report

Abstract IgA pemphigus (IGAP) is a rare autoimmune bullous disease characterized by IgA deposits on keratinocyte cell surfaces. The IGAP is classified into: 1) subcorneal pustular dermatosis (SPD) type, and 2) intraepidermal neutrophilic (IEN) IgA dermatosis type. So far, only 9 children with IGAP have been described in the literature, of whom only 3 with SPD type. We report a 3-year-old boy with SPD type of IGAP. Clinically, he presented with pruritic vesicles, pustules and erosions on the face, trunk, groin area, and extremities. Histopathology showed subcorneal pustules containing a few acantholytic cells. Direct immunofluorescence (DIF) test of Tzanck smear showed intercellular IgA deposits on the surface of the groups of epidermal cells. Oral dapsone and prednisone induced remission after two weeks; the treatment was discontinued 11 months later, and complete remission was achieved during 19 months without any treatment. Direct immunofluorescence of Tzanck smear is a simple, sensitive, rapid and non-aggressive test, very suitable for the diagnosis of IGAP in children.