Efficacy of Systemic Dapsone Treatment for Pyoderma Gangrenosum: A Retrospective Review

October 2018 | Volume 17 | Issue 10 | Original Article | 1058 | Copyright © 2018

Ryan S. Din BS,a,b William G. Tsiaras MD PhD,a,b David G. Li BS,b,c Arash Mostaghimi MD MPH MPAa,b

aHarvard Medical School, Boston, MA bDepartment of Dermatology, Brigham and Women’s Hospital, Boston, MA cTufts University School of Medicine, Boston, MA

Abstract

INTRODUCTION: Pyoderma gangrenosum (PG) is a neutrophilic dermatosis commonly treated with steroid immunosuppression. The utility of dapsone as a non-immunosuppressive treatment for PG has been reported in case reports and series. We sought to evaluate the response and tolerability of concurrent systemic dapsone therapy for treating PG. METHODS: We reviewed PG patients treated with systemic dapsone at Massachusetts General Hospital and Brigham and Women’s Hospital from 2000-2015. A treatment episode was defined as a minimum of 4 weeks of dapsone therapy with a documented response of complete, partial, or no improvement in wound healing. RESULTS: 27 patients treated with systemic dapsone met inclusion criteria. 15.6% of treatment episodes demonstrated a response of complete healing, 81.3% of treatment episodes demonstrated a response of partial improvement, and 1 patient (3.1%) demonstrated no response. 9 patients (33.3%) had documented side effects of varying severity, with one (3.7%) requiring cessation of dapsone therapy. DISCUSSION: Systemic dapsone therapy may represent an effective and tolerable non-immunosuppressive adjuvant treatment for PG wound healing. J Drugs Dermatol. 2018;17(10):1058-1060.

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INTRODUCTION

Pyoderma gangrenosum (PG) is a non-infectious neutrophilic dermatosis commonly associated with underlying systemic disease. Its etiology is postulated to be a result of abnormal neutrophil function.1 While treatment centers on immunosuppressive therapy such as systemic glucocorticoids, steroid-sparing agents are often preferred for patients requiring longer durations of therapy.Dapsone is an antibiotic with anti-inflammatory properties that has shown utility in neutrophil-mediated disease. While the utility of dapsone for treatment of PG had been reported in case reports and small series, it has not been evaluated across a population.2–6 We sought to evaluate the response of PG patients treated with systemic dapsone and to examine its safety and tolerability.

METHODS

We conducted a retrospective review of PG patients treated with systemic dapsone at Brigham and Women’s Hospital and Massachusetts General Hospital from 2000-2015. Patients were identified using the Partners Research Patient Data Repository (RPDR), a clinical data registry, and an ICD-9 code search (686.01) for pyoderma gangrenosum using previously published methods.7Each patient chart was manually reviewed for a diagnosis of PG and treatment with dapsone including start and end dates, responses of complete, partial, or no wound resolution, and adverse effects as documented by the primary clinician. In cases where the start or end date of dapsone administration could not be verified, the earliest and/or latest date of dapsone administration recorded in the chart was used. A treatment episode was defined as a minimum of 4 weeks of systemic dapsone treatment. Data were recorded in Research Electronic Data Capture (REDCap).

RESULTS

Chart review revealed 27 PG patients receiving oral dapsone with a total of 32 episodes of treatment. 81.5% of patients were female, and the average age was 61.2 + 20.2 years (Table 1). The most common comorbidities were inflammatory bowel

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