Linear IgA Dermatosis Medication

Updated: Jun 21, 2018
  • Author: Mark Tye Haeberle, MD; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

Large, randomized, placebo-controlled, double-blind studies have not been performed for the treatment of linear IgA dermatosis in children or adults. Most cases have been reported to respond to dapsone or sulfapyridine. [20, 21] Some clinicians favor the use of sulfapyridine because of the lower incidence of adverse effects [22] ; however, sulfapyridine is not available in the United States. Some patients' conditions may not respond to sulfapyridine but do respond to treatment with dapsone. A response may be seen in 48-72 hours. Other reportedly useful medications include prednisone, sulfamethoxypyridazine, colchicine, dicloxacillin, mycophenolate mofetil, and intravenous immunoglobulin.

Tetracycline and niacinamide combination therapy has been reported as a possible therapeutic option. [23] This regimen, or niacinamide with any tetracycline-class antibiotic, has been well documented in the treatment of bullous pemphigoid.

Rituximab has shown efficacy in the treatment of bullous dermatoses and has been reported in the treatment of linear IgA dermatosis. [24, 25]

Drug-induced disease may be treated merely by withdrawal of the offending agent. In cases of linear IgA dermatosis induced by vancomycin, new lesions stop forming within approximately 2 weeks of withdrawal. [26] Particularly severe cases of drug-induced linear IgA dermatosis respond to a short course of oral corticosteroids.

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Leprostatic agents

Class Summary

These agents have been shown to be beneficial in the treatment of linear IgA dermatosis.

Dapsone (Avlosulfon)

Dapsone is bactericidal and bacteriostatic against mycobacteria; the mechanism of action is similar to that of sulfonamides where competitive antagonists of PABA prevent formation of folic acid, inhibiting bacterial growth.

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Corticosteroids

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.

Prednisone (Deltasone)

Prednisone is an immunosuppressant used for the treatment of autoimmune disorders; it may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocyte and antibody production.

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Anti-inflammatory agents

Class Summary

These agents modulate events leading to inflammatory reactions.

Colchicine

Colchicine decreases leukocyte motility and phagocytosis in inflammatory responses.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Dicloxacillin (Dycill, Dynapen)

Dicloxacillin is used in the treatment of infections caused by penicillinase-producing staphylococci. It may be used to initiate therapy when staphylococcal infection is suspected.

Tetracycline (Achromycin V, Actisite, Sumycin)

Although an antibiotic, tetracycline has proven effective in linear IgA dermatosis, either alone or in conjunction with niacinamide (2 g/d). Efficacy may be due to anti-inflammatory properties.

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Immunoglobulins

Class Summary

These agents are used to improve the clinical and immunologic aspects of the disease. They may decrease autoantibody production and increase solubilization and removal of immune complexes.

Immune globulins intravenous (Carimune NF, Flebogamma, Gammagard Liquid, Gammagard S/D, Privigen)

Immune globulins neutralize circulating antibodies and down-regulate proinflammatory cytokines, including INF-gamma; They block Fc receptors on macrophages, suppress inducer T and B cells, augment suppressor T cells, and block the complement cascade.

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DMARDs, Other

Class Summary

Rituximab is a genetically engineered chimeric murine/human monoclonal antibody against human CD20, a molecule present in normal and malignant B lymphocytes.

Rituximab (Rituxan)

Rituximab is described in case reports as an effective treatment for linear IgA dermatosis.

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