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Indications and efficiency of dapsone in IgA vasculitis (Henoch-Schonlein purpura): case series and a review of the literature

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A Correspondence to this article was published on 19 October 2019

Abstract

Immunoglobulin A (IgA) vasculitis (Henoch-Schonlein purpura (HSP)) is the most common vasculitis in children. It is characterized by purpuric rash, arthritis, gastrointestinal, and/or renal involvement. Spontaneous resolution is the typical outcome. In chronic cutaneous manifestations of IgA vasculitis, dapsone seems to show a good effectiveness. Multiple case reports and case series about dapsone in chronic IgA vasculitis are available. However, no clear evaluation of its indications, its effectiveness, or its usage guidelines (optimal dosage or duration of treatment) is available. We reviewed the published cases of IgA vasculitis treated by dapsone and compared them with 2 similar cases that we encountered. Seventeen patients (ranging from 22 months old to 16 years old) with severe or persistent clinical signs of IgA vasculitis were included. Dapsone showed good results on the resolution of cutaneous lesions but not on renal manifestations. Complications (methemoglobinemia) were observed on 1 patient. Half of the patients relapsed after treatment discontinuation. The difference between the time lapse before initiation and the duration of the treatment was not significant.

Conclusion: We suggest that dapsone can have a positive effect in chronic IgA vasculitis when cutaneous manifestations last more than 6 weeks at the dosage of 1–2 mg/kg once per day during 1 week.

What is Known:

• IgA vasculitis or Henoch-Schonlein purpura is the most common vasculitis in children and affects mostly small vessels of the skin, kidney, and gastrointestinal tract. It resolves spontaneously in most of the cases. Exceptionally, cutaneous lesions can last several weeks.

• Dapsone is a bacteriostatic antibacterial sulfonamide drug found to be effective in the treatment of some inflammatory dermatological diseases like IgA vasculitis.

What is New:

• Dapsone is effective against chronic purpuric lesion (> 6 weeks) at the minimal dose of 1 mg/kg/day.

• Relapse occurs frequently after discontinuation but responds after a second course of treatment. A longer duration of treatment or a delay in treatment by dapsone does not seem to influence the relapse rate.

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Abbreviations

ACE:

Angiotensin-converting enzyme

CRP:

C-reactive protein

DIF:

Direct immunofluorescence

HSP:

Henoch-Schonlein purpura

IgA:

Immunoglobulin A

NSAIDs:

Non-steroidal anti-inflammatory drugs

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Authors and Affiliations

  1. Department of Pediatrics, Hôpital Civil Marie Curie, CHU of Charleroi, 140 Chaussée de Bruxelles, 6042, Charleroi (Lodelinsart), Belgium

    Céline Roman, Bogdan Dima, Laurence Muyshont, Thierry Schurmans & Olivier Gilliaux

  2. Pediatric Department, Cliniques de l’Europe Sainte-Elisabeth, 206 Avenue de Frélaan, 1180, Brussels, Belgium

    Bogdan Dima

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  1. Céline Roman
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  2. Bogdan Dima
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  4. Thierry Schurmans
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  5. Olivier Gilliaux
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Contributions

C.R. and OG wrote the manuscript. C.R., B.D., L.M., T.S. and O.G. contributed to collect clinical data and to the analyzis of data. O.G. supervised the work.

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Correspondence to Olivier Gilliaux.

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Communicated by Peter de Winter

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Roman, C., Dima, B., Muyshont, L. et al. Indications and efficiency of dapsone in IgA vasculitis (Henoch-Schonlein purpura): case series and a review of the literature. Eur J Pediatr 178, 1275–1281 (2019). https://doi.org/10.1007/s00431-019-03409-5

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  • DOI: https://doi.org/10.1007/s00431-019-03409-5

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