Dapsone in dermatology and beyond

Abstract

Dapsone (4,4′-diaminodiphenylsulfone) is an aniline derivative belonging to the group of synthetic sulfones. In 1937 against the background of sulfonamide era the microbial activity of dapsone has been discovered. Shortly thereafter, the use of dapsone to treat non-pathogen-caused diseases revealed alternate antiinflammatory mechanisms that initially were elucidated by inflammatory animal models. Thus, dapsone clearly has dual functions of both: antimicrobial/antiprotozoal effects and anti-inflammatory features similarly to non-steroidal anti-inflammatory drugs. The latter capabilities primarily were used in treating chronic inflammatory disorders. Dapsone has been investigated predominantly by in vitro methods aiming to get more insights into the effect of dapsone to inflammatory effector cells, cytokines, and/or mediators, such as cellular toxic oxygen metabolism, myoloperoxidase-/halogenid system, adhesion molecules, chemotaxis, membrane-associated phospholipids, prostaglandins, leukotrienes, interleukin-8, tumor necrosis factor α, lymphocyte functions, and tumor growth. Moreover, attention has been paid to mechanisms by which dapsone mediates effects in more complex settings like impact of lifespan, stroke, glioblastoma, or as anticonvulsive agent. Additionally, there are some dermatological investigations in human being using dapsone and its metabolites (e.g., leukotriene B4-induced chemotaxis, ultraviolet-induced erythema). It could be established that dapsone metabolites by their own have anti-inflammatory properties. Pharmacology and mechanisms of action are determining factors for clinical use of dapsone chiefly in neutrophilic and/or eosinophilic dermatoses and in chronic disorders outside the field of dermatology. The steroid-sparing effect of dapsone is useful for numerous clinical entities. Future avenues of investigations will provide more information on this fascinating and essential agent.

Decreased fibrinolytic potential and morphological changes of fibrin structure in dermatitis herpetiformis

“…An established therapeutic modality in DH is dapsone administration. The favourable effect of dapsone on fibrinolysis and fibrin structure in DH evidenced by the present study represents a novel aspect of its therapeutic action complementary to previously hypothesized mechanisms [26]. In addition, it furthers our understanding of dapsone effectiveness in cryofibrinogenemia-associated diseases [10] (Kárpáti et al, 1997) and different vasculitis forms [27].…”

Dapsone induced photosensitivity in Indian women: a rare case

“…By oral route dapsone is mainly metabolized to monoacetyldapsone (MADDS) and hydroxylamine dapsone (DDS-NOH). 14 Our patient had typical dapsone-induced photoallergic reaction with redness and itching over exposed skin which showed worsening on sun exposure within four weeks after starting dapsone. Dapsone was stopped and supportive therapy with topical emollients and oral antihistaminics alongwith avoidance of sunexposure led to significant improvement within 1 week.…”

The role of dapsone in refractory idiopathic granulomatous mastitis

“…In vitro studies suggest that Dapsone inhibits the expression of Beta 2 integrin (CD11/CD18) mediated adhesion of neu-trophils, interfering in the inflammatory pathway. [3] Dapsone has been used to treat Dermatitis Herpetiformis (DH) and Sweet Syndrome (SS). Histopathology of these lesions usually shows significant neutrophil infiltrates, which may help explain Dapsone's efficacy in both DH and SS.…”