Broadening the Therapeutic Horizon of Topical Dapsone Beyond Acne

A new scoping review has evaluated the efficacy and safety of topical dapsone in managing mucocutaneous diseases other than acne vulgaris.¹ Researchers identified promising results, especially in localized disease, immunosuppressed patients, and those who avoid exposure to systemic therapies.

Background

Dapsone (4,4′-Diamino diphenyl sulfone), known for its antimicrobial, anti-inflammatory, and antioxidant properties, has been widely used for treating a variety of mucocutaneous disorders, most commonly in oral form. While systemic dapsone is effective, it is also associated with significant adverse effects, including hemolysis, methemoglobinemia, and neuropathy. In contrast, topical dapsone formulations (5% and 7.5% gels) offer lower systemic absorption and reduced risk of serious adverse events.² These topical forms are FDA-approved for acne, but emerging clinical data suggest broader dermatological applications.

Methods

A comprehensive literature search was conducted across PubMed, Web of Science, and Scopus databases, with 1953 clinical pieces being identified. A total of 56 eligible articles published up to April 2025 were selected, including randomized controlled trials, case reports, case series, and cohort studies. Topical dapsone was used in 6 main categories of dermatological diseases.

Rosacea

Topical dapsone (5% and 7.5%) was effective, especially in papulopustular and erythematotelangiectatic types. Patients showed clinical improvement with minimal adverse effects, including a lowered rate of burning, and some studies reported comparable efficacy to standard treatments like metronidazole.

Vesiculobullous Diseases

In those with dermatitis herpetiformis, several cases showed lesion clearance with 5% dapsone, especially in combination with gluten-free diets. Another case was recorded of a patient with Toxic Epidermal Necrolysis/Stevens-Johnson Syndrome after taking amoxicillin, who showed healing of oral lesions with adjunct topical dapsone 3 times a day.

Neutrophilic Dermatoses

In patients with pyoderma gangrenosum, partial (85.7%) or complete improvement (9.5%) was reported in most patients using topical dapsone, often as adjunct therapy. Other conditions, such as subcorneal pustular dermatosis and erosive pustular dermatosis, responded well to dapsone, especially when systemic therapies were ineffective or not tolerated. One patient with subcorneal pustular dermatosis saw complete lesion remission within 3 weeks. Another case series demonstrated the efficacy of 5% gel twice daily for mild to moderate Erosive pustular dermatosis of the scalp. However, evidence in patients with folliculitis decalvans is mixed. While one study showed reduced flare-ups, another reported worsening symptoms.

Vasculitis
Cases of leukocytoclastic vasculitis and erythema elevatumdiutinum demonstrated improvement with dapsone, particularly in localized disease or when systemic therapy was not suitable. In the case of an 81-year-old man with a clinical diagnosis of erythema elevatumdiutinum, complete resolution of lesions was met when oral dapsone was added. Furthermore, a patient with localized leukocytoclastic vasculitis saw disease resolution within 3 weeks with the use of 5% gel.

Cutaneous Leishmaniasis

A randomized trial of 68 participants showed improved outcomes when niosomal dapsone gel was used alongside weekly intralesional meglumine antimoniate therapy. The dapsone-treated group exhibited a complete response rate of 86.8% and no recurrences were reported after a year.

Other Diseases

Positive responses were also noted in conditions like pustular psoriasis, granuloma faciale (50% improvement), granuloma annulare, and acne agminata, suggesting a broader utility for topical dapsone in inflammatory and granulomatous disorders.

Safety Profile

Overall, topical dapsone was generally well-tolerated, with mild local adverse events such as dryness, erythema, peeling, flaking, tightness, stinging, nasopharyngitis, headache, and sensitivity. Serious systemic adverse effects were rare due to minimal absorption and no significant hematologic changes were observed, even in patients with G6PD deficiency. However, 4 cases of methemoglobinemia were reported, primarily due to overuse or accidental application in children. All recovered fully after treatment with methylene blue and supportive care.

Conclusion

The authors acknowledged several limitations, as most of the utilized publications consisted of case reports written in English

“Consequently, it is crucial to interpret the results, bearing in mind that further investigation, mainly through more robust methodological studies, is necessary for all clinical uses of dapsone rather than acne,” the investigators wrote.

Overall, topical dapsone is a promising treatment for various localized, chronic, and inflammatory mucocutaneous conditions beyond acne. Despite a few reports of methemoglobinemia, the safety profile remains favorable, but larger, well-designed clinical trials are needed to validate its broader dermatological applications.

References

1. Abtahi-Naeini B, Sattari H, Afshar K, Rastegarnasab F, Pourmahdi-Boroujeni M. Efficacy and Safety of Topical Dapsone in Dermatology: A Scoping Review of Clinical Studies. J Cosmet Dermatol. 2025;24(10):e70494. doi:10.1111/jocd.70494

2. Wang X, Wang Z, Sun L, Liu H, Zhang F. Efficacy and safety of dapsone gel for acne: a systematic review and meta-analysis. Ann Palliat Med. 2022;11(2):611-620. doi:10.21037/apm-21-3935