dapsone
Sources réglementaires consultées
Indications approuvées
- Dermatite herpétiforme et lèpre dans le cadre d’une polychimiothérapie.
Contre-indications
Absolues
- Hypersensibilité à la dapsone ou aux sulfones.
Mises en garde cliniques
- Elle peut provoquer agranulocytose, anémie aplasique et autres dyscrasies mortelles. Réaliser une numération hebdomadaire le premier mois, mensuelle pendant 6 mois puis tous les 6 mois ; arrêter en cas de baisse significative. — DailyMed, set_id 839d7440-ba0e-4c56-b648-d374b155cf03
- Elle peut provoquer hémolyse et méthémoglobinémie dose-dépendantes, plus sévères en cas de déficit G6PD ou de maladie cardiopulmonaire ; corriger l’anémie sévère avant de commencer. — DailyMed, set_id 839d7440-ba0e-4c56-b648-d374b155cf03
- Arrêter en cas de SCAR, NET, dermatite exfoliative ou syndrome d’hypersensibilité à la dapsone. — DailyMed, set_id 839d7440-ba0e-4c56-b648-d374b155cf03
Interactions médicamenteuses
- SévèrePyriméthamine ou autres antifolates
Mécanisme: Ils augmentent le risque de toxicité hématologique.
Recommandation: Éviter ou intensifier la surveillance de la numération.
DailyMed, set_id 839d7440-ba0e-4c56-b648-d374b155cf03
- SévèreTriméthoprime
Mécanisme: Il peut augmenter réciproquement les concentrations et la méthémoglobinémie.
Recommandation: Surveiller numération, méthémoglobine et toxicité.
DailyMed, set_id 839d7440-ba0e-4c56-b648-d374b155cf03
- SévèreRifampicine
Mécanisme: Elle peut réduire les concentrations de dapsone de 7 à 10 fois.
Recommandation: Dans la lèpre, la notice ne requiert pas d’ajustement pour cette interaction ; maintenir la prise en charge spécialisée du schéma.
DailyMed, set_id 839d7440-ba0e-4c56-b648-d374b155cf03
Effets indésirables
Communs (≥1%)
Hémolyse, méthémoglobinémie, nausées, céphalées et éruption
Rares mais graves
Agranulocytose, anémie aplasique, NET et syndrome d’hypersensibilité à la dapsone
Grossesse et allaitement
Utiliser pendant la grossesse uniquement en cas de nécessité claire. La source réglementaire orale locale ne fournit pas de données sur l’allaitement ; vérifier la notice en vigueur avant de décider entre traitement et allaitement.
Bibliographie récente (PubMed)
Objective: IgA vasculitis (IgAV), previously named as Henoch-Schönlein purpura, is the most frequent systemic vasculitis in children. In adults, IgAV is less common although it is associated with more severe disease. In fact, the frequency of glomerulonephritis (referred to as IgAV nephritis) in adults is higher than in children and tends to present more severely, with around 10-30% of those affected eventually progressing to end-stage renal disease. In this review, we describe the pathophysiology, main clinical features, diagnosis of the disease, and latest clinical data regarding IgAV therapy. Methods: A narrative literature review, primarily based on articles published in PubMed, was conducted. In addition to discussing the main aspects of glucocorticoids and conventional disease-modifying drugs used in the management of IgAV, this review focuses on the latest information reported regarding biologics and potential future therapies. Results: Glucocorticoids are the first-line therapy for IgAV, especially in adults with severe manifestations. Colchicine, dapsone, and methotrexate can be useful for controlling minor manifestations. Several immunomodulatory agents, such as cyclosporine A, tacrolimus, and mycophenolate mofetil, have shown favorable results as glucocorticoid-sparing agents. Leflunomide has shown promising results but requires further study. The use of rituximab has demonstrated efficacy in reducing relapse frequency, lowering the cumulative glucocorticoid burden, and achieving long-term remission of the disease in children and adults with IgAV. Immunoglobulins and plasma exchange therapy can also be useful in difficult and life-threatening situations. Other potential therapies with encouraging results include TRF-budesonide, B-cell-directed therapy, B-cell-depleting agents, sodium-glucose cotransporter-2 inhibitors, endothelin receptor antagonists, and complement pathway inhibitors. Conclusions: Glucocorticoids are the first-line therapy for IgAV, espe
Acne is one of the most common dermatological conditions to affect women of childbearing age, so it is important to consider the safety of long-term acne treatments on women who could become pregnant. In this review article, we clarify what management options are available to treat acne during pregnancy. Topical treatments, typically first-line for acne, such as azelaic acid, clindamycin, erythromycin, metronidazole, benzoyl peroxide, salicylic acid, dapsone, and retinoids, were reviewed. Systemic treatments, such as zinc supplements, cephalexin, cefadroxil, amoxicillin, azithromycin, erythromycin, and corticosteroids, typically second-line for acne, were also reviewed. Alternative treatments such as light therapy and cosmetic procedures were also evaluated. Due to recommendation of sunscreen utilization during acne treatments, sunscreen usage during pregnancy was also assessed. Management of acne during unplanned pregnancy was discussed in further detail regarding safety and adverse effects. Through summarized tables and examples of studies demonstrating safety and efficacy of treatments, the following is a resource for providers and patients to utilize for management of acne during pregnancy.
Sweet syndrome is a neutrophilic dermatosis characterized by an autoinflammatory nature and a sterile neutrophilic infiltrate. It presents with tender, erythematous, edematous papules or plaques, often accompanied by fever. Aim of this review is to summarize the most meaningful aspects of Sweet syndrome, critically discussing old paradigms and novel findings. A search of the English-language literature was conducted using the terms "Sweet syndrome" and "acute febrile neutrophilic dermatosis." MEDLINE (via PubMed) and Web of Science (WOS) databases were consulted up to June 30, 2024. Since its first identification, new clinical and histopathological variants of Sweet syndrome have been described, highlighting its heterogeneity. Additionally, a multitude of clinical conditions have been increasingly reported in association with Sweet syndrome, ranging from malignancies, autoimmune and infectious disorders. The pathogenesis of the disease is unclear and varies according to the associated conditions. One unifying mechanism is the aberrant activation, proliferation, and skin homing of neutrophils. The mainstay of treatment remains systemic corticosteroids; alternatives include colchicine, dapsone, and potassium iodide. Traditional immunosuppressants, biologic agents, and small molecules have also been described as effective in treating Sweet syndrome. Sweet syndrome is a heterogeneous condition with an elusive pathogenesis. Most cases resolve with corticosteroids, but some remain refractory to various therapies, representing an unmet medical need. Recent evidence on the pathomechanisms underlying Sweet syndrome suggests that not only innate but also adaptive immunity might play roles. Further experimental studies are needed and may help identify new therapeutic targets in the future.
Pyoderma gangrenosum is a rare neutrophilic dermatosis that results in painful cutaneous ulcers and is frequently associated with underlying hematologic disorders, inflammatory bowel disease, or other autoimmune disorders. Pathogenesis involves an imbalance between proinflammatory and anti-inflammatory mediators, leading to tissue damage from neutrophils. First-line treatment options with the greatest evidence include systemic corticosteroids, cyclosporine, and tumor necrosis factor alpha inhibitors. Other steroid-sparing therapies such as dapsone, mycophenolate mofetil, intravenous immunoglobulin, and targeted biologic or small molecule inhibitors also have evidence supporting their use. Wound care and management of underlying associated disorders are critical parts of the treatment regimen. Dapsone is a sulfonamide related drug used for the therapy of leprosy and dermatitis herpetiformis. Dapsone has been linked with rare cases of idiosyncratic liver injury, similar to that seen with the sulfonamides.