Dapsone in the Management of Pemphigus and Pemphigoid: Rediscovery of its Long-Lost Efficacy

Abstract

Introduction Autoimmune mucocutaneous blistering dermatoses (AMCBD) are a group of disorders characterized by the production of autoantibodies that target specific adhesion molecules of the skin and/or mucous membranes. As a result, there is blister formation on the skin with or without mucous membrane involvement. Systemic corticosteroids have been used as the mainstay of treatment in AMCBD. However, due to the debilitating side effects associated with their use, there is significant morbidity and mortality, especially on the fragile elderly patients. Although the efficacy of dapsone in the treatment of AMCBD was identified decades ago, few recent studies shed light on that. Hence, further studies are needed to evaluate the efficacy of dapsone as a single agent in maintaining disease remission in patients with AMCBD. Materials and methods An observational retrospective study was performed. Patients with a known diagnosis of bullous pemphigoid (BP) or pemphigus vulgaris (PV) who are treated with dapsone with or without low-dose systemic corticosteroids were included in the study, and their medical files were reviewed. Results A total of seven patients were included (three males and four females). All patients showed a satisfactory response to dapsone, achieving disease remission in a short period of time with no serious side effects necessitating treatment cessation. Conclusions Our findings support that dapsone may have a corticosteroid-sparing effect in the management of AMCBD. Further studies are warranted to confirm our findings.

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“…As a sulfone antibiotic, dapsone is used in general medicine to treat various infections—Hansen’s disease, Plasmodia, Pneumocystis, Toxoplasmodia, and others [ 7 ]. In dermatological practice, dapsone is used to treat a variety of neutrophilic dermatoses of non-microbial origin like bullous pemphigoid, dermatitis herpetiformis, urticarial dermatoses, cutaneous lupus, and others [ 7 , 8 , 9 , 10 ].…”