Dapsone in hidradenitis suppurativa: A case series of 56 patients

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a challenging treatment. Current guidelines reserve dapsone as a third line agent for patients with mild to moderate HS. To our knowledge, only four small case series have been reported. The objective of this study was to assess the effectiveness and safety of dapsone in our clinical practice. A retrospective observational single-center study of 56 HS patients who underwent treatment with dapsone from May 1, 2015, to June 1, 2021, was performed. The Hidradenitis Suppurativa Clinical Response (HiSCR) scale was used to evaluate the response to treatment. Fifty-six patients were included, 66% of which were men, with a median age of 33 years. Most of them had mild or moderate disease and belonged to LC2 follicular phenotype. All patients had been refractory to first-line treatments. Dapsone was prescribed at doses of 50-150 mg/day. 62.5% of the patients achieved HiSCR after 12 weeks of treatment. No serious adverse reactions were detected. The median duration of treatment was 8 months. After multivariate analysis, an association was found between the presence of fistulous tracts and the risk of non-response to the drug. In four of the dapsone responders, oral retinoids were added to achieve a sustained response. Limitations include the retrospective and non-controlled nature of this study. In conclusion, dapsone is an effective and well-tolerated option for long-term HS treatment, and in this series, it was mainly chosen for patients with LC2 phenotype. It would be interesting to study combination with retinoids and other management options.

Dapsone in Hidradenitis Suppurativa: A Systematic Review

“…Some patients responded to a lower dose while others required a relatively higher dose. The studies by Murray et al [24] and Lopez-Llunell et al [35] did not show any significant treatment response with dapsone. One study reported the need for maintenance dosage therapy to sustain positive patient outcomes [31].…”

“…Furthermore, the effects of the adverse events on treatment outcomes were not significant in most cases. However, adverse events such as headache and nausea did result in the discontinuation of dapsone therapy [24,32,35], as well as the deterioration of the condition only in three patients. Concerns over the safety and side effects of dapsone can sometimes lead to dose reductions and shorter duration of drug administration, both of which can affect its effectiveness.…”

Rethinking Hidradenitis Suppurativa Management: Insights into Bacterial Interactions and Treatment Evolution

“…Although it is considered to be a third-line option, dapsone is an antineutrophilic and antieosinophilic antibiotic that is also a possibility for those with mild-to-moderate HS without a G6PD deficiency [ 31 , 32 ]. A 2021 retrospective study features 56 patients with mostly mild to moderate disease and were prescribed 50–150 mg/day of dapsone.…”

“…A total of 62.5% of patients achieved HiSCR50 after 12 weeks of treatment. Analysis from the study also identifies an association between tract presence and non-response risk [ 31 ]. These results support dapsone as a treatment for patients with mild to moderate HS that have not developed fistulas or sinus tracts.…”

Dissecting cellulitis of the scalp: A review on clinical characteristics and management options in a series of 14 patients

“…It can be used alone or in combination with isotretinoin or surgical techniques. 8 Patients with stage disease III and/or inadequate response to previous treatments could take benefit from TNF-alpha antagonists. The most used agent has been adalimumab.…”