Dosage

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Dapsone given in oral doses of 25-100 mg daily has been reported to be effective in the treatment of annular subacute cutaneous LE (SCLE); urticarial vasculitic lesions complicating systemic LE; the nonscarring form of chronic discoid LE (DLE), today designated as LE tumidus (Fig. 27.2) (Kuhn et al. 2000); bullous eruptions of systemic LE; and oral ulcerations (Coburn and Shuster 1982, Hall et al. 1982, McCormack et al. 1984, Ruzicka and Goerz 1981). In contrast, the response of chronic DLE to dapsone (100-150 mg/day) has been largely disappointing (<30% response rates), especially when lesions are widespread or disseminated (Lindskov and Reymann 1986, Ruzicka and Goerz 1981). Because exacerbation of cutaneous disease occurs when discontinuing therapy, a maintenance dose of 25-50 mg/day is almost always needed (Duna and Cash 1995). Dapsone might be an alternative to antimalarial agents when the latter cause adverse reactions (Lo et al. 1989).

Table 27.1. Indications for dapsone therapy in dermatology (Katz 1999, Lang 1979, Zhu and Stiller 2001)

Erythema elevatum diutinum Dermatitis herpetiformis Linear IgA dermatosis Cicatricial pemphigoid Bullous pemphigoid Pemphigus vulgaris Actinomycetoma

Sneddon-Wilkinson disease (subcorneal pustular dermatosis)

Pyoderma gangrenosum

Sweet syndrome

Eosinophilic cellulitis

Granuloma annulare

Erosive lichen planus

Relapsing polychondritis

Systemic lupus erythematosus

Subacute cutaneous lupus erythematosus

Discoid lupus erythematosus

Bullous lupus erythematosus

Fig. 27.2. a 10-year-old Turkish girl with non-scarring form of discoid lupus erythematosus before therapy. b Almost total clearing of skin lesions 3 weeks after therapy with dapsone

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