Dapsone as Second-Line Treatment for Cutaneous Lupus Erythematosus? A Retrospective Analysis of 34 Patients and a Review of the Literature

Abstract

Background: A variety of therapeutic options have been reported for cutaneous lupus erythematosus (CLE); one of these is dapsone. However, no high priority has been given to this drug. Objective: To determine whether dapsone is an effective and safe treatment alternative in patients with LE. Methods: We reviewed the literature and analyzed retrospectively 34 CLE patients who were treated with dapsone as monotherapy or combined with antimalarials. We assessed the course of the disease under treatment, response, concomitant treatment and side effects. Results: Six patients went into remission, 14 patients improved, and in 6 patients disease remained constant during the observation period. Dapsone was discontinued in 9 patients: in 4 due to reversible side effects and in 5 patients due to poor efficacy. Conclusion: Our data confirm that dapsone with/without antimalarials is effective in more than 50% of patients with CLE and could be used as second-line therapy for CLE.

Transient effectiveness of dapsone for skin lesions in a patient with discoid lupus erythematosus

“…Antimalarial drugs such as HCQ and chloroquine (unapproved in Japan) are often recommended as the first choice for systemic therapy [1,2,6,7,8] . Dapsone, immunosuppressants such as methotrexate and corticosteroids are the second option [1,2,3] .…”

“…For cutaneous lupus erythematosus (CLE) patients, topical treatments of corticosteroid or calcineurin inhibitor are recommended worldwide [1,2] . As the next step, hydroxychloroquine (HCQ) and/or chloroquine are often recommended as the first choice for systemic therapy, and dapsone (diaminodiphenyl sulfone, DDS), along with immunosuppressants such as methotrexate and corticosteroids belong to the second option group [3] . However, the effectiveness and limitation of dapsone for patients with discoid LE (DLE) and the mechanisms of action are not fully understood.…”

S2k guideline for treatment of cutaneous lupus erythematosus – guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV)

“…Ujiie and co‐workers reported a further case of LEP successfully treated with dapsone and reviewed 10 further Japanese cases with LEP. A retrospective analysis of 34 patients by Klebes and co‐workers reported that dapsone with or without antimalarials was effective in more than 50% of patients with CLE . In summary, dapsone has been reported to be effective in SCLE, LEP, urticarial vasculitis and oral ulcerations .…”

“…A retrospective analysis of 34 patients by Klebes and co-workers reported that dapsone with or without antimalarials was effective in more than 50% of patients with CLE. 99 In summary, dapsone has been reported to be effective in SCLE, LEP, urticarial vasculitis and oral ulcerations. 94,[100][101][102][103][104] Dapsone was also effective in bullous lupus erythematosus (BLE), also after initial unsuccessful treatment with HCQ and systemic corticosteroids.…”

Epidermolysis Bullosa Acquisita in Children: Case Series

“…Основными препаратами, используемыми в лечении данного заболевания, являются системные глюкокортикостероиды, азатиоприн, метотрексат, циклофосфамид, а также дап-сон в качестве монотерапии или в комбинации с преднизолоном, циклоспорином и колхицином [3]. Дапсон обладает антибактериальным и противовоспалительным эффектом, что связано с его ингибирующим действием на нейтрофилопосредованное повреждение тканей, обусловленным активацией превращения миелопероксидазы в неактивное соединение, и подавлением образования токсичных форм кислорода [4]. В зависимости от тяжести процесса может быть выбрана как монотерапия дапсоном, так и комбинированный его прием с преднизолоном.…”