Antibiotics used in nonbacterial dermatologic conditions

Center for Clinical Studies, Houston, Texas 77030, USA.
Dermatologic Therapy (Impact Factor: 1.6). 01/2012; 25(1):38-54. DOI: 10.1111/j.1529-8019.2012.01496.x
Source: PubMed


The majority of nonbacterial dermatological conditions treated with antibiotics benefit from the anti-inflammatory properties of these medications, usually dapsone or tetracycline. Many other antimicrobials are used to treat noninfectious conditions. The following chapter is an overview of select noninfectious dermatological conditions for which antibiotics are used, with a focus on the most common antibiotics used for their nonantimicrobial properties.

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    ABSTRACT: Dapsone is a synthetic sulfone that is used as an antibiotic in humans and animals to prevent and treat diseases including leprosy, tuberculosis, malaria, and Pneumocystis carinii pneumonia and Toxoplasma gondii encephalitis in acquired immune deficiency syndrome ( AIDS) patients as well as in anti-inflammatory conditions, such as dermatitis herpetiformis. However, this drug is also associated with several adverse effects, including dose-related hemolysis, methemoglobinemia, psychosis, peripheral neuropathy, agranulocytosis, aplastic anemia, hypersensitivity syndrome, sulfone syndrome, and others. Of these effects, methemoglobinemia is the most common side effect of dapsone, which leads to functional anemia and cellular hypoxia with symptoms of cyanosis, headache, fatigue, tachycardia, weakness, and dizziness. Thus, this review summarizes relevant information on the structure, mechanism of action, clinical indication, and adverse reactions of dapsone.
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    ABSTRACT: Background Management of antihistamine refractory chronic idiopathic urticaria (CIU) has poorly defined therapeutic options. Objective To evaluate the efficacy of dapsone (4,4′-diaminodiphenylsulfone) in antihistamine refractory CIU compared with placebo. Methods Twenty-two patients with antihistamine refractory CIU were randomly assigned to 100 mg of dapsone daily or placebo for 6 weeks in a 14-week double-blind, placebo-controlled crossover trial. End points were measured from a daily diary that reflected the weekly hive score, the weekly itch score, and a visual analog scale (VAS) score. Secondary to a carryover effect, the first period results were analyzed as a parallel design that compared placebo with dapsone directly by using repeated-measures analysis. Results After 6 weeks, the patients in the dapsone arm showed mean improvement over baseline in VAS (2.3 [95% CI, 0.6-4.1], P = .01), urticaria score (–3.5 [95% CI, –6.2 to –0.9], P = .01), and itch score (–4.8 [95% CI, –7.6 to –2.1], P = .001), whereas the placebo arm showed no improvement over baseline for VAS, urticaria, or itch scores. Dapsone showed greater improvement compared with placebo for itch (P = .047) and VAS (P = .04). Of the 22 patients, 3 showed complete resolution of hives and itch with dapsone, whereas 31% and 41% had ≥50% resolution of hives and itch, respectively. No serious adverse effects were observed with dapsone. Conclusion To our knowledge, this is the first double-blind, placebo controlled study of dapsone in CIU and indicates that dapsone has efficacy in patients with antihistamine refractory CIU.
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