Dapsone: use in immunobullous disorders

Abstract

Dapsone and other sulfonamides have been used successfully in the treatment of patients witha variety of blistering skin diseases. The patients most likely to respond to dapsone therapyhave predominantly neutrophilic infiltrate in their skin e.g. dermatitis herpetiformis and linearIgA disease. The precise mechanism of action of dapsone is unknown. In vitro studies haveshown that dapsone can interfere with the production of and response to neutrophilicchemotactants and that it may impair the neutrophils' ability to localize to sites ofinflammation and produce toxic oxygen intermediates. The safe use of dapsone requires anunderstanding of the pharmacology and adverse effects of the drug. Hemolytic anemia andmethemoglobinemia are two of the dose-related adverse effects. Agranulocytosis, motorneuropathy, and dapsone hypersensitivity syndrome are some of the severe idiosyncraticeffects that can occur in patients treated with dapsone. Careful patient selection and closemonitoring of patients during therapy with dapsone are critical elements in the safe andeffective use of dapsone for patients with blistering skin diseases.