Dapsone

Dapsone and other sulfonamides have been used successfully in the treatment of patients with a variety of blistering skin diseases. The patients most likely to respond to dapsone therapy have a predominantly neutrophilic infiltrate in their skin. Therefore the blistering diseases with the most consistent responses to dapsone therapy include dermatitis herpetiformis and linear IgA disease. Dapsone's precise mechanism of action is unknown. In vitro studies have shown that dapsone can interfere with the production of and response to neutrophil chemoattractants and that it may impair the neutrophils' ability to localize to sites of inflammation and produce toxic oxygen intermediates. The safe use of dapsone requires an understanding of the pharmacology and adverse effects of the drug. Hemolytic anemia and methemoglobinemia are two of the dose-related adverse effects. Agranulocytosis, motor neuropathy, and dapsone hypersensitivity syndrome are some of the severe idiosyncratic effects that can occur in patients treated with dapsone. Dapsone is an effective drug for the management of patients with some blistering disease, especially those with predominant neutrophilic infiltrates in the skin. Careful patient selection and close monitoring of patients during therapy with dapsone are critical elements in the safe and effective use of dapsone for patients with blistering skin diseases.