Dapsone first came into medicine as an antibacterial agent but was found to be less effective than other sulfonamides. Likewise its activity against tuberculosis was disappointing. Nevertheless, it has been the main stay in the treatment of leprosy. It also has some action against malaria and other parasites. Nowadays, after leprosy, dapsone has proved as a valuable drug in the treatment of a wide range of mainly uncommon and rare dermatoses. In this article, we present a comprehensive review of the mechanisms of action, pharmacokinetics, uses, adverse reactions and management of side effects of dapsone.    

Introduction: Dapsone gel (5%) is found to be effective in treating acne. The study was to develop a topical formulation of dapsone in Iran. Objective: Determination of appropriate formulation for generic form of this drug in the treatment of acne. Materials and Methods: Samples of the base of gel were made in the range of 0. 3%-5% by dissolving Carbomer 934P in distilled water, and their physical properties and pH were evaluated. Then, Dapsone was dissolved in its appropriate solvent, diethylene glycol monoethyl ether (DEG) and were introduced into gel base. Afterwards, using Design Expert software 13 samples and in the next step 17 samples were designed, made and their rheological properties and pH were evaluated. Then, two formulations were selected and were characterized by drug content, physicochemical properties, rheology and stability and found to be in accordance with the US Pharmacopeia. Results: The gel bases containing carbomer in the range of 1-3% were appropriate. The pH value of gel bases in first 13 samples were between 5-7 and the viscosity range between 16530-2980000(cp). The viscosity of range of 17 designed samples was between 1100-760000(cp). The final sample with 1% carbomer content had the viscosity range of 14075-268000(cp) and drug release of 78/1% after 3 hours. The sample with 2% carbomer content had the viscosity range of 92660-557000(cp) and drug release of 76% after 3 hours. Conclusion: Viscosity and drug release of both samples were in accordance with pharmacopeia. However, the sample containing 1% carbomer is more commercially suitable and more appropriate lowering pH of the skin.

Objective: Familial Mediterranan Fever is an hereditary autoinflammatory disease that presents with recurrent febrile attacks and poly serositis. Colchicine is the only known treatment in this diease. However, nearly 5-10% of patients are resistant to colchicines. There are many different modalities in colchicine resistant patients, biologic and immunosupressive drugs being the known ones. We studied the efficacy of Dapsone as an anti-inflammatory drug in children with FMF who did not tolerate colchicine well.Methods: This is a case series study in 10 patients who had FMF on the base of Tel-Hashomer criteria and did not tolerate colchicine or did not respond to it well. Patients took 2mg/kg dapsone in single dose, during 6 months.FindingsIn four patients episodic attacks returned after 27 days, so the drug was discontinued. One patient refused to continue the study; in five patients dapsone was taken in average for 8 months and 6 days, at least for 6 months. These five patients had no episodes of attack during the following observation.Conclusion: Dapsone could control episodic attacks of FMF in 50% of cases. It might be considered as an alternative therapy in FMF cases not responding to colchicine.

Objective(s): Multiple Sclerosis (MS) is an inflammatory disorder wherein the myelin of nerve cells in the central nervous system is damaged. In the current study, we assessed the effect of Dapsone (DAP) on the improvement of behavioral dysfunction and preservation of myelin in the cuprizone (CPZ) induced demyelination model via targeting Nrf2 and IKB. Materials and Methods: MS was induced in C57BL/6 mice through diet supplementation of CPZ (0. 2%) for 6 weeks, and DAP (12. 5 mg/kg/day, IP) was administered for the last 2 weeks of treatment. Pole test and rotarod performance test, LFB and H&E staining, and Immunohistochemistry (IHC) staining of p-Nrf2 and p-IKB were performed. Furthermore, superoxide dismutase (SOD) and nitrite were measured. Results: DAP treatment prevented body loss induced by CPZ (P<0. 001). Pole test showed that CPZ increased latency time to fall (P<0. 0001) but the latency to reach the floor in the DAP-CPZ group was significantly shorter (P<0. 0001). Rotarod performance test showed the effect of CPZ in reducing fall time in the CPZ group (P<0. 0014), however, DAP significantly increased fall time (P=0. 0012). In LFB staining, DAP reduced demyelination induced by CPZ. CPZ significantly decreased p-Nrf2 and elevated p-IKB levels compared with the control group (P<0. 0001), but in DAP-treated groups markedly modified these changes (P<0. 0001). CPZ increased the brain nitrite levels and reduced SOD activity, but in DAP-treated considerably reversed CPZ-induced changes. Conclusion: These data support the suggestion that the beneficial properties of DAP on the CPZ-induced demyelination are mediated by targeting Nrf2 and NF-kB pathways.

Several factors contribute to the development of gastric erosions, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and stress. These factors can cause or worsen gastrointestinal ulcers by activating inflammatory pathways or by altering gastric mucosal blood flow. Dapsone is an antimicrobial compound with anti-inflammatory properties. The aim of this study was to evaluate the protective effects of dapsone against gastric erosions induced by alcohol, stress, or indomethacin. Gastric damage was induced in male rats in three different experimental models: ethanol (5 ml/kg, p. o. )-, water-immersion stress-, and indomethacin (30 mg/kg, p. o. )-induced ulcer. Rats in each of these three experimental models were divided into five groups: Normal group, 2. Control group (gastric damage+vehicle), 3. Gastric damage+dapsone 1 mg/kg, 4. Gastric damage+dapsone 3 mg/kg, 5. Gastric damage+dapsone 10 mg/kg. In this study, the J-score ulcer index and histopathological assessment were performed. In addition, inflammatory cytokines levels, NF-κ B expression, and MPO activity were determined. Dapsone reduced the tissue injuries and erosion area in all three experimental groups compared to the control group. In addition, serum levels of inflammatory cytokines, TNF-alpha, and IL-1β were reduced in the dapsone treatment groups. The expression of NF-κ B and tissue concentration of myeloperoxidase (a marker of neutrophil activation) was also reduced in rats given dapsone. To conclude, dapsone exhibits significant protective effects against the development of experimental gastric erosions in rats, and these effects seem to be related to its anti-inflammatory and antioxidant properties.

Background and aim: Pemphigus vulgaris is an autoimmune vesiculobullous disorder. Prior to the advent of glucocorticoid therapy, it was often fatal. Now its mortality and morbidity is due to high dose glucocorticoid complications rather than the disease itself. This study was aimed to determine the effect of dapsone as a second adjuvant in the treatment of pemphigus vulgaris.Materials and methods: In this quasi-experimental open prospective study, 22 patients with moderate to severe pemphigus vulgaris were treated with prednisolone, azathioprine and dapsone. They were observed for 12-18 months.Results: Patients consisted of 10 females and 12 males with mean age of 41.71 years. The mean duration to reach to the maintenance dose of prednisolone (7.5 mg daily) was 13 months. No major relapse was observed but minor relapses were seen in 6 patients with mean prednisolone dose of 13.8 mg daily. Hemolysis was detected in only one patientand 4 patients had a little drop in hemoglobin level. We observed no other severe dapsone induced adverse reaction.Conclusion: These findings suggest that dapsone can be used as a second adjuvant for more rapid tapering of steroid dosage without significant flare of the disease.