Dermatitis Herpetiformis Medication

Updated: Mar 06, 2020
  • Author: Jami L Miller, MD; Chief Editor: Dirk M Elston, MD  more...
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Medication

Medication Summary

Treatment consists of a gluten-free diet plus pharmacotherapeutic agents. Dapsone is indicated as a primary treatment for dermatitis herpetiformis. Sulfapyridine, a previous mainstay of therapy for dermatitis herpetiformis, is no longer available in most countries. However, sulfasalazine is partly metabolized to sulfapyridine. It may be considered for off-label use in dermatitis herpetiformis in patients who are unable to tolerate a high enough dose of dapsone. [51] Corticosteroids may also be considered.

Case reports have described use of rituximab for recalcitrant dermatitis herpetiformis. [52, 58] Cases have also been described using colchicine [59] and tetracycline. [60, 61, 62]

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Anti-inflammatory and Immunomodulatory Agents

Class Summary

Dapsone is considered the treatment of choice. Other anti-inflammatory and immunomodulatory agents may be required if dapsone is insufficient or not tolerated.

Dapsone

The precise mechanism by which dapsone works in dermatitis herpetiformis has not been established. It is a competitive antagonist of para-aminobenzoic acid (PABA) and prevents bacteria from using PABA for folic acid synthesis. It is indicated as a primary treatment for dermatitis herpetiformis.

Sulfasalazine (Azulfidine)

Sulfasalazine elicits anti-inflammatory effects. It has a high affinity for distribution to connective tissues. Sulfasalazine is metabolized to 5-aminosalicylic acid and sulfapyridine.

Rituximab (Rituxan, Truxima)

Rituximab is a humanized monoclonal antibody. It binds to CD20 antigen, inducing complement- or antibody-mediated cytolysis.

Colchicine (Colcrys, Gloperba, Mitigare)

Colchicine elicits various effects on neutrophil migration, degranulation, and activation that may diminish inflammation.

Tetracycline

The mechanism by which tetracycline may act for use in dermatitis herpetiformis is not established.

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Corticosteroids

Class Summary

Systemic corticosteroids may be considered.

Prednisone (Deltasone)

Prednisone is a glucocorticosteroid that elicits mild mineralocorticoid activity and moderate anti-inflammatory effects. It controls or prevents inflammation by controlling the rate of protein synthesis, suppressing migration of polymorphonuclear leukocytes (PMNs) and fibroblasts, reversing capillary permeability, and stabilizing lysosomes at cellular level.

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