Dapsone for HS

Updated: 3 days ago


The epidemic of over-prescribing antibiotics is real. We know that our disease is a difficult one for our physicians as there aren’t many courses of treatment to offer. Each of us has walked out of the Dermatologist’s office with a prescription for antibiotics shaking our heads because we don’t have an infection, so how does this help? Most antibiotics don’t help because they kill the bacteria but they don’t stop it from growing in the first place. If you are being required to take antibiotics, please continue to read on. This article is not promoting antibiotics.


Benefits of Dapsone


Dapsone has been used for many years for HS and has been very effective as it acts similarly to non-steroidal antiinflammatory drugs. Dapsone is an anti-inflammatory antibiotic, and while it is an antibiotic, it’s different in that it stops the growth of bacteria as opposed to killing it. Recently, Dapsone has been made available as a new topical gel-based preparation (Aczone) for the treatment of mild to moderate acne vulgaris in adolescents and adults.


Dapsone is safe to use long-term whereas many antibiotics are not. Dapsone spares you the steroidal side effects that come with other antibiotics while still impacting your HS. Another benefit to Dapsone is that if you become resistant you don’t have to worry about developing an infection and not being able to be treated, as it the case with most other antibiotics and the resistance that’s built up. The only other risk is resistance to treatment of malaria and leprosy, which is very rare. This medication is used to treat a certain type of skin disorders. It is also treats Hansen's disease leprosy, malaria, Pneumocystis pneumonia, and toxoplasmosi, to name a few.


As an anti-inflammatory agent Dapsone finds utility in treating numerous blistering

dermatologic diseases such as:


Pemphigus vulgaris

IgA pemphigus

Bullous pemphigoid

Bullous - form of systemic lupus erythematosus

Linear IgA dermatoses - associated with medication exposure, especially vancomycin

Dermatitis herpetiformis - associated with the gluten hypersensitivity known as celiac disease

Also used in the management of dermatoses characterized by neutrophilic or eosinophilic cutaneous infiltrates like Sweet’s syndrome and pyoderma gangrenosum.


The pharmacoeconomic benefit due to the low cost of Dapsone is also worth mentioning.


History of Dapsone


The resistance to malaria and leprosy years ago drove the development of Dapsone.

Dapsone was first synthesized in 1908. At that time, Dapsone was not envisioned as a therapeutic agent, but was the result of pure chemical science ambition. The latter capabilities primarily were used in treating chronic inflammatory disorders.

Science Jargon


It has the ability to inhibit neutrophil myeloperoxidase and eosinophil myeloperoxidase makes it effective in treating numerous diseases characterized by inflammatory infiltrates with neutrophils and eosinophils. Importantly, general cross-reactivity between dapsone and other sulfonamide-derived drugs is not observed.


Sulfone-derived therapy that dermatologists often use for neutrophilic skin diseases, can prevent neutrophil chemotaxis and cellular adhesion as well as reduce production of reactive oxygen species and myeloperoxidase. Because of the influx of neutrophils noted in the epidermal–dermal junction, bullous SLE is frequently responsive to dapsone. In addition, dapsone's antiinflammatory effects include decreasing prostaglandin, leukotriene, and cytokine (e.g., IL-8) production.60 Thus dapsone can be used in patients with CLE, particularly SCLE. In a retrospective study of 34 patients with CLE treated with dapsone, 41% showed signs of clinical improvement, and 18% demonstrated complete remission. Patients with SCLE particularly responded well.


Unique characteristics of Dapsone include the association of antimicrobial/antiprotozoal and antiphlogistic effects in a broad range of indications places dapsone in a unique position in the spectrum of non-steroidal antiphlogistic drugs.

Currently, no other drug used in medicine possesses such a wide variety of beneficial properties as follows:


Combination of antimicrobial/antiprotozoal effects (utilized, e.g. in the treatment of opportunistic infections in patients with acquired immunodeficiency syndrome).


Safety of long-term treatment (e.g., life-long use in leprosy, long-term or chronic intermittent therapy of inflammatory dermatoses).


Unique powerful disease-specific antiphlogistic activities (e.g., prompt decrease of pruritus and control of skin lesions in dermatitis herpetiformis; fast amelioration of loxoscelism associated with brown recluse spider bites).


Steroid-sparing effects (e.g., long-term treatment in autoimmune blistering diseases and as an adjuvant treatment in bronchial asthma).


CNS-protective effects (anticonvulsive effects, reduction of stroke-associated tissue damage, inhibition of glioblastoma).


Finally, the pharmacoeconomic benefit due to the low cost of dapsone deserves to be mentioned.


Dapsone oral tablets can also be found under other names in other countries, including: Dapsone® (Australia), Daps® (Argentina), Avlosulfon® (Canada), Disulone® (Czech Republic), Dapson®, (Denmark, Egypt, the Netherlands, Norway), Dapson-Fatol® (Germany), Dapsoderm-X® (Mexico), Dapsona® (Paraguay), Lepravir® (Phillipines), Sulfona® (Portugal), Dopsan® (Thailand) and Lennon-Dapsone® (South Africa).


Before initiation of Dapsone therapy, patients must undergo a careful clinical evaluation that includes a complete history and physical examination, routine laboratory checks and follow-up visits. Laboratory tests include a complete blood count with differential and reticulocytes count. Liver and renal function tests and urinalysis should be performed monthly in the first 3–6 months. Special caution when treating patients with Dapsone must be considered in those who are receiving or have been exposed to other drugs or agents that are capable of inducing met-Hb production or haemolysis or in patients with pre-existing anaemia.


Like any pharmaceutical, Dapsone comes with side effects and risks. Please do your research and discuss with your physician and/or pharmacist.


hsconnect.org


This is an awareness article for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.


Written by Denise Panter Fixsen

Edited by Brindley Kons

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