NEW ORLEANS – Topical dapsone is a novel and effective treatment for atrophie blanche ulcerations.
Atrophie blanche (also known as livedoid vasculopathy) is a therapeutic challenge. The etiology of this chronic and painful condition is unclear. The current standard care, which consists of low-dose aspirin, pentoxifylline, pain medications, and conservative wound dressings, has a suboptimal success rate in reducing pain and healing the ulcers, Dr. Erik Maus observed at the annual meeting of the American Academy of Dermatology.
He reported on 10 patients with biopsy-confirmed – and/or clinical findings consistent with – atrophie blanche, all of whom had failed to respond adequately to conventional measures. At the Memorial Hermann Center for Wound Healing at the University of Texas, Houston, they were placed on dapsone gel 5% (Aczone) twice daily, usually in conjunction with compression stockings or compression bandages when edema or venous stasis was present. The clinical results were impressive, according to Dr. Maus of the university.
One patient quickly discontinued topical dapsone after reporting feeling vaguely ill. Of the nine patients who continued on the drug, seven (78%) experienced rapid and steady cutaneous healing and reduced pain; their longstanding wounds closed in 6-20 weeks.
Patients described the topical therapy as easy to use. No one reported discomfort in applying dapsone gel to open wounds.
One patient relapsed when she ran out of the medication. Healing resumed when she restarted treatment.
Dapsone gel’s likely mechanism of action in atrophie blanche involves inhibition of neutrophilic migration to the ulcerated sites, Dr. Maus speculated.
Atrophie blanche is characterized by painful, persistent ulcerations of the ankle and dorsal surface of the foot. The condition affects mainly young to middle-aged women. Areas of healed ulceration are marked by ivory-colored atrophic scars surrounded by sclerotic skin with hyperpigmentation and peripheral telangiectasias. Although altered local or systemic control of coagulation is believed to play a role in some cases, the etiology of atrophie blanche often remains obscure.
This study was conducted without corporate sponsorship. Dr. Maus declared having no relevant financial interests.