Sulfasalazine and dermatitis herpetiformis

Abstract

Dermatitis herpetiformis that is unable to be controlled using dapsone and a gluten-free diet presents a therapeutic challenge. Three cases that responded well to sulfasalazine are presented. Two cases, who were unable to tolerate dapsone, had a rapid response to sulfasalazine, without apparent side-effects. The third case with dapsone-responsive blistering dermatoses, presumed to be dermatitis herpetiformis on the basis of serology, showed an excellent clinical response to sulfasalazine, but after 6 weeks of therapy had to cease it because of side-effects. Sulfasalazine is metabolized variably to sulfapyridine, a sulphonamide known to be an effective therapy for dermatitis herpetiformis but no longer available. Sulfasalazine should be considered as a management option for dermatitis herpetiformis.

Treatment of subepidermal immunobullous diseases

“…Monitoring for potential side effects is critical given the risk of hemolytic anemia, methemoglobinemia, neuropathy, and hypersensitivity (discussed in more detail previously in the section describing the use of dapsone in the treatment of BP). Sulfasalazine and sulfamethoxypyridazine can be useful in patients who cannot tolerate dapsone or when dapsone is ineffective 98,99 ; however, the mainstay of therapy is initiation of a gluten-free diet, as this reduces the need for medication, resolves underlying enteropathy, and reduces the risk of lymphoma in these patients. 100 Patients should be referred to a dietician for guidance on adhering to a gluten-free diet, as many food ingredients contain gluten.…”

Dermatitis Herpetiformis, the Celiac Disease of the Skin!

“…As these mentioned medications also induce adverse effects, controls are necessary monthly or 6 monthly. Enteric-coated forms of the drugs could be prescribed (35) .…”

Dermatitis herpetiformis

“…34,39 While dapsone is the mainstay of pharmacologic therapy for DH, several reports have described successful treatment with sulfasalazine and sulfamethoxypyridazine. 1,[41][42][43] It is likely that these medications are effective because of their metabolism to sulfapyridine, and that the latter is therapeutic via a mechanism similar to that of dapsone. 1,34,41 Because sulfasalazine is variably absorbed, clinical outcome may be less predictable; therefore, it is considered a second-line agent to treat DH.…”