Adjuvant therapy of bullous pemphigoid with dapsone

Thirteen patients with recurrent severe widespread recalcitrant bullous pemphigoid (BP) were studied. These patients had been initially treated with prednisone and azathioprine, and clinically responded. However, they frequently continued to have flare-ups or activation of the disease while still on treatment with high doses of these drugs. The addition of dapsone, as an adjuvant to the treatment, helped to produce a complete clinical remission in 12 patients (92%). In addition, there was a statistically significant difference in the median dose of prednisone, before and after the institution of dapsone, and in the maintenance dose of prednisone. Patients were tapered off prednisone more easily than before and did not flare at lower doses of prednisone as previously. It is suggested that, in patients with severe, recalcitrant, recurrent disease, the addition of dapsone to the existing regime of corticosteroids and/or immunosuppressive drugs, may be beneficial. This may be especially valuable to patients in whom corticosteroids have been used for prolonged periods and in whom increasing the corticosteroid dose further may be associated with significant side-effects.