Leukocytoclastic vasculitis resolution with topical dapsone

Leukocytoclastic vasculitis (LCV) is a disease characterized by inflammation of small vessels presenting with petechiae and palpable purpura. Leukocytoclastic vasculitis often spontaneously resolves within weeks and requires only symptomatic treatment. Chronic or severe disease can require systemic treatment with agents such as colchicine, dapsone, or corticosteroids, which are effective but carry a risk for serious adverse events. These side effects and/or medical contraindications preclude some patients from taking systemic medications for LCV. We present a case of biopsy-proven LCV in a 60-year-old woman that resolved after treatment with topical dapsone. Systemic dapsone is effective at treating LCV but requires screening for glucose-6-phosphate dehydrogenase deficiency and routine monitoring of blood counts, and its possible adverse effects include neuropathy, blood dyscrasia, and hypersensitivity syndrome. Topical dapsone may provide similar efficacy with far fewer adverse effects. Given this drug's favorable side-effect profile compared to the currently available alternatives, we believe it is a reasonable option in selected patients.