Dapsone Therapy for Pustular Psoriasis: Case Series and Review of the Literature

Abstract

Background: Pustular psoriasis is an uncommon psoriasis variant, clinically characterized as small sterile pustules on an erythematous base. Evidence for therapy is lacking, and many currently employed systemic therapeutics carry risks of significant side effects, without specifically targeting disease etiology which includes the aggregation of neutrophils. Observations: We report therapy with the anti-neutrophil agent dapsone in 5 patients with pustular psoriasis and provide a brief review of the literature. Four patients responded to oral dapsone and 1 to topical dapsone therapy. All 5 patients had previously failed multiple topical and systemic treatments. In 2 cases, oral dapsone allowed for the discontinuation of other systemic agents. One patient stopped oral dapsone due to a side effect of sleep disturbance. Conclusion: Dapsone has a much safer side effect profile and may target the pathophysiology of pustular psoriasis more directly than many other systemic agents. As such, dapsone should be considered for the treatment of patients with pustular psoriasis.

Subcorneal Pustular Dermatosis: A Review of 30 Years of Progress

“…A familial contribution is seen in some cases of pustular psoriasis, and one report suggested that there was a genetic component to SPD [16]. Both pustular psoriasis and SPD usually respond to dapsone [66][67][68][69].…”

“…Maintenance therapy at a lower dosage is necessary to prevent relapse. Dapsone may cause hematologic adverse effects, such as methemoglobinemia, hemolytic anemia, agranulocytosis, hypersensitivity syndrome, renal toxicity, hepatic toxicity, or peripheral motor neuropathy [67,73]. Hemolytic reactions and agranulocytosis are dose dependent [67].…”

“…Dapsone may cause hematologic adverse effects, such as methemoglobinemia, hemolytic anemia, agranulocytosis, hypersensitivity syndrome, renal toxicity, hepatic toxicity, or peripheral motor neuropathy [67,73]. Hemolytic reactions and agranulocytosis are dose dependent [67]. Additionally, glucose-6-phosphate dehydrogenase levels must be checked prior to initiation of dapsone therapy, as deficient patients are at increased risk of severe hemolysis with its use.…”

“…Additionally, glucose-6-phosphate dehydrogenase levels must be checked prior to initiation of dapsone therapy, as deficient patients are at increased risk of severe hemolysis with its use. Current recommendations are a complete blood count weekly for the first month, monthly for the next 5 months, and biannually thereafter [67]. Many patients will respond to dapsone.…”

“…For one, dapsone, which is considered first-line therapy for SPD, has been used as a successful alternative for annular pustular psoriasis [67,68]. Immunobiologic agents designed to inhibit the proinflammatory cytokine TNF-a-such as adalimumab, infliximab, and etanercept-have been used to treat pustular psoriasis.…”