Erythema multiforme bullosum due to dapsone

Area of Science:

• Dermatology
• Infectious Diseases
• Pharmacology

Background:

• Leprosy, a chronic infectious disease, is primarily treated with Dapsone (DDS).
• Adverse drug reactions to DDS can complicate treatment regimens.
• Erythema multiforme bullosum (EMB) is a severe mucocutaneous reaction potentially linked to DDS therapy.

Observation:

• Two patients with tuberculoid leprosy presented with erythema multiforme bullosum (EMB).
• Prominent prodromal symptoms included burning and itching sensations.
• Both patients had a history of urticaria and bronchial asthma, suggesting potential atopic predisposition.

Findings:

• Dapsone (DDS) was identified as the causative agent for EMB in these cases.
• Successful management was achieved through a desensitization protocol.
• This involved slow induction of DDS under the cover of corticosteroids and antihistamines.

Implications:

• Highlights the risk of DDS-induced EMB in leprosy patients.
• Demonstrates the efficacy of a steroid-and-antihistamine-assisted DDS desensitization strategy.
• Informs clinical practice regarding the management of severe cutaneous adverse drug reactions in leprosy treatment.