Treatment of ocular cicatricial pemphigoid with sulfasalazine

To assess the outcome of patients with ocular cicatricial pemphigoid (OCP) treated with sulfasalazine as an alternative to dapsone.

Retrospective noncomparative case series.

Nine patients with biopsy-proven OCP and previous dapsone-related adverse effects (hemolysis and gastrointestinal disturbances) treated with oral sulfasalazine.

Clinical data were abstracted from patients' medical records.

Patients' symptoms, ocular inflammation, conjunctival scarring, complete blood cell count (including reticulocyte count).

At the initiation of sulfasalazine therapy, ocular inflammation was controlled in all patients but one. Mean follow-up was 12 months (range, 2-35 months). Median oral sulfasalazine dosage was 3 g (range, 1-4 g). The disease remained controlled with sulfasalazine alone in four patients (45%). Two patients (22%) required adjunctive oral cyclophosphamide. Adverse effects necessitating drug withdrawal occurred in three patients (33%): hemolysis in two and gastrointestinal disturbances in one.

Sulfasalazine may be useful in OCP patients with previous dapsone-related adverse effects.