Adjunctive Dapsone Therapy Effective for Pyoderma Gangrenosum

Pyoderma gangrenosum
Pyoderma gangrenosum
The use of dapsone may be effective as adjunctive therapy for patients with pyoderma gangrenosum.

The use of systemic dapsone as an adjunctive therapy in patients with pyoderma gangrenosum (PG) has demonstrated efficacy and safety, according to the results of a retrospective review conducted at Massachusetts General Hospital and Brigham and Women’s Hospital, both in Boston, Massachusetts, between 2000 and 2015. Study findings were published in the Journal of Drugs in Dermatology.

The investigators sought to assess the response to and tolerability of dapsone used concurrently with other treatments: systemic corticosteroids (65.6%), topical corticosteroids (40.6%), antibiotics (37.5%), intralesional corticosteroids (34.4%), and tumor necrosis factor-alpha inhibitors (25.0%) in patients with PG. A treatment episode was described as a minimum of 4 weeks receiving dapsone therapy with a documented response of complete, partial, or no improvement in wound healing.

A total of 27 patients with PG who were receiving oral dapsone were evaluated, with 32 episodes of treatment investigated. The average participant age was 61.2±20.2 years; 81.5% of the study enrollees were women. The most common comorbidities among the participants included inflammatory bowel disease (25.9%) and postoperative sepsis (22.2%). Most lesions were reported on the lower extremities (55.6%), trunk (18.5%), and peristomal regions (18.5%). Among the participants, the most common peak dapsone dosages were 50 and 100 mg (37.5% of patients).

Overall, 96.9% of treatment episodes had a documented healing response, with 15.6% exhibiting a complete response and 81.3% exhibiting a partial response. The average time reported for an initial treatment response was 5.3 weeks, and the average duration of dapsone therapy was 14.3 months.

Overall, 33.3% (9/27) of participants experienced documented adverse effects, with the most common being hemolytic anemia and methemoglobinemia. The relatively low rates of toxicity imply that the tolerability and safety of dapsone in patients with PG are similar to that in the general population.

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The investigators concluded that the results of this review must be considered in the context of the study design. As this was a small retrospective study, larger samples may have the ability to detect less common adverse effects associated with dapsone use, including leukopenia and agranulocytosis. Prospective, randomized controlled trials are warranted to definitively establish the role played by dapsone therapy in patients with PG.

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Din RS, Tsiaras WG, Li DG, Mostaghimi A. Efficacy of systemic dapsone treatment for pyoderma gangrenosum: a retrospective review. J Drugs Dermatol. 2018;17(10):1058-1060.