Dapsone to Treat Moderate-to-Severe Hidradenitis Suppurativa: A Retrospective Case-Series

November 2023 | Volume 22 | Issue 11 | e12 | Copyright © November 2023


Published online October 12, 2023

Brittany Baroudi BSa, Arjun M. Bashyam BAa, Steven R. Feldman MD PhDa,b,c,d, Rita O. Pichardo MDa

aCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
bDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC 
cDepartment of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 
dDepartment of Dermatology, University of Southern Denmark, Odense, Denmark

DISCUSSION

Dapsone is a sulfone drug that possesses anti-microbial and anti-inflammatory properties and is used in a broad range of indications. In the case of severe disease with previously failed treatment attempts, TNF-alpha inhibitors (adalimumab, infliximab) may be an appropriate treatment option. Since these biologics and dapsone address the main pathophysiology of HS with their TNF-alpha TNF-inhibiting properties, the use of these two agents in conjunction may have a synergistic benefit. Few studies observing the effects of oral dapsone on HS have been published.17,18 The most recent study was completed in 2011 and concluded that out of 24 patients, only 38% reported improvement. The patients who showed improvement had mild to moderate (Hurley Stage I-II) disease. A total of four patients in this study had severe (Hurley Stage III) HS and did not show any improvement. This study indicated that dapsone therapy is possible for patients with HS, particularly with milder cases.17 Another retrospective study followed five patients with HS who received dapsone therapy with improvement being reported in all five patients within 4-12 weeks.18 Overall, these previous studies support our results. However, our study differs from previous studies, with 89.5% of patients having severe (Hurley Stage III) disease.

In this retrospective review, 13/19 (68%) patients treated with dapsone showed improvement, while 6/19 (32%) did not have any change in symptoms (Table 3). Of the 13 patients who responded to treatment, 11 patients had advanced disease (Hurley Stage III; Table 1), suggesting the potential dapsone has as adjunctive therapy for moderate to severe disease (Hurley Stage II-III). The majority of the patients who showed improvement were also on combination therapy, either with immunomodulatory or antibiotic compounds. Of the two patients who were treated with monotherapy, one resulted in clinically significant improvement, and the other had no change. 

This study has several limitations. The effectiveness of dapsone used as monotherapy cannot be determined as the majority of the patients were taking dapsone in combination with other agents. In addition, a quality-of-life survey to assess the overall satisfaction of patients before and after treatment was not performed. The possibility of disease recurrence while patients were either on dapsone or at the cessation of dapsone treatment also was not assessed. Finally, observations were based on a small patient population with no control group.

CONCLUSIONS

Dapsone may be an effective treatment option when used in combination with other therapies for moderate to severe (Hurley Stage II-III) HS. Further studies are required to clarify the effect of dapsone used as a monotherapy, to evaluate which treatment options work best in combination with dapsone, and to assess the possibility of disease recurrence in patients with moderate to severe disease who initially respond to dapsone therapy.

DISCLOSURES

Steven Feldman has received research, speaking, and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation.  He is the founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients' adherence to treatment. Rita Pichardo has received consulting support from Abbvie. Brittany Baroudi and Arjun Bashyam have no conflicts to disclose.

REFERENCES

  1. Kurzen H, Kurokawa I, Jemec GB, et al. What causes hidradenitis suppurativa? Exp Dermatol. 2008;17(5):455-456; discussion 457-472. 
  2. Mortimer PS, Lunniss PJ. Hidradenitis suppurativa. J R Soc Med. 2000;93(8):420-422.
  3. Lapins J, Asman B, Gustafsson A, et al. Neutrophil-related host response in hidradenitis suppurativa: a pilot study in patients with inactive disease. Acta Derm Venereol. 2001;81(2):96-99.
  4. Mozeika E, Pilmane M, Nurnberg BM, et al. Tumour necrosis factor-alpha and matrix metalloproteinase-2 are expressed strongly in hidradenitis suppurativa. Acta Derm Venereol. 2013;93(3):301-304.
  5. Jemec GB, Revuz J, Leyden J. Hidradenitis Suppurativa. 1 ed: Springer-Verlag Berlin Heidelberg; 2006.
  6. Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol. 1983;22(5):325-328.
  7. Gener G, Canoui-Poitrine F, Revuz JE, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology. 2009;219(2):148-154.
  8. Dessinioti C, Zisimou C, Tzanetakou V, et al. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1 year follow-up. Clin Exp Dermatol. 2016;41(8):852-857.
  9. Join-Lambert O, Coignard H, Jais JP, et al. Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa. Dermatology. 2011;222(1):49-58.
  10. Shuja F, Chan CS, Rosen T. Biologic drugs for the treatment of hidradenitis suppurativa: an evidence-based review. Dermatol Clin. 2010;28(3):511-521,523-514; quiz 522-513.
  11. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39(6):971-974.
  12. Soria A, Canoui-Poitrine F, Wolkenstein P, et al. Absence of efficacy of oral isotretinoin in hidradenitis suppurativa: a retrospective study based on patients' outcome assessment. Dermatology. 2009;218(2):134-135.
  13. Coleman MD. Dapsone: modes of action, toxicity and possible strategies for increasing patient tolerance. Br J Dermatol. 1993;129(5):507-513.
  14. Wozel G, Blasum C. Dapsone in dermatology and beyond. Archives of Dermatological Research. 2014;306(2):103-124.
  15. Suda T, Suzuki Y, Matsui T, et al. Dapsone suppresses human neutrophil superoxide production and elastase release in a calcium-dependent manner. Br J Dermatol. 2005;152(5):887-895. 
  16. Hurley H. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa and familial benign pemphigus: surgical approach. In: Roenigk RR, HH Jr, ed. Dermatologic surgery: principles and practice. 2nd ed. New York Marcel Dekker. 1996:623-645.
  17. Yazdanyar S, Boer J, Ingvarsson G, et al Dapsone therapy for hidradenitis suppurativa: a series of 24 patients. Dermatology. 2011;222(4):342-346.
  18. Kaur MR, Lewis HM. Hidradenitis suppurativa treated with dapsone: A case series of five patients. J Dermatolog Treat. 2006;17(4):211-213.
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