Dapsone dermatitis herpetiformis

Dapsone Dermatitis herpetiformis, erythema elevatum diutinum, pemphigus, pemphigoid, bullous lupus erythematosus See also Chapter 47. 

Dapsone is approved for the treatment of an autoimmune blistering skin disease, dermatitis herpetiformis. This intensely pruritic eruption is characterized histologically by a dense dermal infiltration of neutrophils and subepidermal blisters. Other skin diseases in which dapsone is helpful are linear immunoglobulin A (IgA) dermatosis, subcorneal pustular dermatosis, leukocytoclastic vasculitis, and a variety of rarer eruptions in which neutrophils predominate, including some forms of cutaneous lupus erythematosus. 

Dermatitis herpetiformis Dapsone is typically effective in 24 h, or sulfapyrldine. Prolonged therapy necessary, a gluten-free diet can help, Antipruritics locally as required. Not other sulphonamides benef dal effect not due to antimicrobial action. Methaemoglobinaemia may complicate dapsone therapy. 

Studies of patients with borderline leprosy have suggested that dapsone has mild immunosuppressive effects (SEDA-18, 30). Thus, it has been given with some success to patients with dermatitis herpetiformis, subcorneal pustular dermatosis, bullous dermatoses, relapsing polychondritis, thrombocytopenic purpura (3), giant cell arteritis (4), rheumatoid arthritis, and systemic lupus erythematosus (5). 

Signs of heart failure with edema, ascites, and severe hypoalbuminemia have been described in the treatment of dermatitis herpetiformis with dapsone (9). 

Cowan RE, Wright IT. Dapsone and severe hypoalbumi-naemia in dermatitis herpetiformis. Br J Dermatol 1981 104(2) 201-4. 

Prussick R, Ah MA, Rosenthal D, Guyatt G. The protective effect of vitamin E on the hemolysis associated with dapsone treatment in patients with dermatitis herpetiformis. Arch Dermatol 1992 128(2) 210-13. 

Dapsone is also the drug of choice for dermatitis herpetiformis and is sometimes used with pyrimethamine for treatment of malaria and with trimethoprim for PCP. 

It may also have ANTIPSYCHOTIC activity, dapiprazole hydrochloride dapiprazole. dapitant [inn] (RPR 100893) is a substituted isoindole, a TACHYKININ RECEPTOR ANTAGONIST, selective for the NK,-receptor subtype. It has potential as an ANTIMIGRAINE AGENT, dapsone [ban, inn, usan] is a sulphone with actions similar to SULPHONAMIDES and with ANTIBACTERIAL activity. It can be used as an antileprotic and for infective dermatitis herpetiformis. and is being investigated for the treatment and prevention of Pneumocystis carinii pneumonia (e.g. in AIDS), daptomycin [ban, inn, usan] is an (aminoglycoside) antibiotic. It has antibacterial properties. 

Trade names Avlosulfon Dapson Dapson-Fatol Maloprim (Combination) Protogen Sulfona Indications Leprosy, dermatitis herpetiformis Category Antibiotic Antimycobacterial Half-life 10-50 hours... 

Dapsone is approved for use in dermatitis herpetiformis and leprosy. It is particularly useful in the treatment of linear immunoglobulin A (IgA) dermatosis, bullous systemic lupus erythematosus, erythema elevatum diutinum, and subcorneal pustular dermatosis. 

Resistance to sulfonamides is now common for N. meningitidiSy as well as in cases of bacillary dysentery. Antibiotics have generally replaced the sulfonamides for these purposes. Sulfonamides, particulady sulfisoxazole and sulfadiazine, are of value in treatment of infections due to Nocardia species, and sulfonamides are effective for trachoma. Inclusion conjunctivitis is also treated with sulfacetamide ointment. Oral administration of a sulfonamide, eg, sulfisoxazole, has been successful for treatment of lymphogranuloma venereum and chancroid Dapsone and sulfonamides have also been used for treatment of the skin disorder dermatitis herpetiformis. Sulfonamides have been used for long term prophylaxis of rheumatic fever, but are being replaced by penicillin for this purpose, except in cases of hypersensitivity to penicillin (19). 

It is mainly used in the treatment of dermatitis herpetiformis for such patients who do not give positive response to dapsone. It is elfeetive in pneumonia. Though more potent than sulfanilamide, it is more toxic and has been replaced by sulfadiazine. 

Coleman MD, Rhodes LE, Scott AK, Verbov JL, Friedmann PS, Breckenridge AM, Park BK. The use of cimetidine to reduce dapsone-dependent metiiaemo obinaernia in dermatitis herpetiformis patients. Br J Clin Pharmacol ( 992) 34, 244-9. 

Ellard GA, Gammon PT, Savin JA, Tan RS-H. Dapsone acetylation in dermatitis herpetiformis BrJ Dermatol (1974) 90,441-4... 

A single case su ests that the effectiveness of dapsone in the treatment of dermatitis herpetiformis may be reduced by ursodeoxycholic add. 

A 61-year-old man taking dapsone 50 mg daily for dermatitis herpetiformis started taking ursodeoxycholic acid 450 mg twice daily for cholecystitis. Two weeks later the dermatitis herpetiformis worsened and the dose of dapsone was increased to 150 mg daily. However, his condition did not improve, so ursodeoxycholic acid was stopped and, as his condition improved, the dapsone dose was reduced to 100 mg, and then 50 mg daily. Two months later ursodeoxycholic acid was restarted and there was again an exacerbation of the dermatitis herpetiformis. The general importance of this isolated report is unknown, but consider the possibility of reduced dapsone effects if ursodeoxycholic acid is also given. 

Agranulocytosis due to dapsone occurs particularly in the first 3 months of therapy, and the risk is increased in patients with dermatitis herpetiformis [52 ]. The mechanism is not known, but it has been proposed that selective preservation of basophils, as found in a patient with severe dapsone-induced agranulocytosis, could be relevant [53 ]. 

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