Dapsone Supported for Treatment of Hidradenitis Suppurativa

The effectiveness and safety of dapsone for the treatment of patients with hidradenitis suppurativa is evaluated.

The safety and efficacy of dapsone for the treatment of hidradenitis suppurativa (HS) was supported in study data published in Dermatologic Therapy.

This retrospective observational study used data from patients with moderate to severe HS from a dermatology center in Barcelona, Spain. Patients who were treated with dapsone from May 2015 to June 2021 were eligible for inclusion. Clinical response to dapsone was assessed using the Hidradenitis Suppurativa Clinical Response (HiSCR) scale. The primary outcome was clinical improvement at week 12, defined as a 50% or greater reduction in total abscess and inflammatory nodule count relative to baselinewith no increase in abscess count or draining fistula count. Multivariate logistic regression models were used to identify correlates of dapsone response.

The study cohort comprised 56 patients with HS, among whom 66.1% were men and 33.9% were women. Median age at baseline was 33.0 (interquartile range [IQR], 23.0-43.0) years; median age at HS onset was 17.0 (IQR, 15.0-21.0) years. At the time of initiating dapsone, 53.6% of patients had mild disease, 23.2% had moderate disease, and 23.2% had severe disease.  

Overall, 62.5% of patients achieved clinical response after 12 weeks of treatment. The majority of responders had mild to moderate disease at baseline; only 30% of patients with severe disease achieved response at week 12. Blood tests revealed no impairment of glucose-6-phosphate dehydrogenase activity in any patient. Adverse events were reported by 28.6% of patients and led to discontinuation in 8.9%. The most common adverse events were anemia, nausea, diarrhea, and headache. No severe reactions occurred.

Median treatment duration was 8 (IQR, 3-14) months. In regression models, the presence of sinus tracts was associated with greater likelihood of non-response (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.5-20.6; P =.012). Although fewer patients with severe disease achieved response, disease severity was not a significant predictor of non-response in fully adjusted models.

Dapsone is typically regarded as a third-line treatment for HS, with few studies assessing its efficacy, it was noted. Data from the current analysis support its effectiveness and safety in clinical practice.

Study limitations included the uncontrolled and retrospective design, as well as the small cohort size. Future randomized controlled trials could better explore the feasibility of dapsone as an HS treatment, the investigators believe.

“Dapsone is an effective and well-tolerated treatment on mild and moderate HS,” investigators wrote. “Severe, Hurley III patients with predominance of sinus tracts and LC1 phenotype do not benefit from this treatment.”

Disclosure: A study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


López-Llunell C, Riera-Martí N, Gamissans M, Romaní J. Dapsone in hidradenitis suppurativa: a case series of 56 patients. Dermatol Ther. Published online October 19, 2021. doi:10.1111/dth.15161