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A case of Sneddon-Wilkinson disease with hypersensitivity to dapsone successfully managed with colchicine (SLMC)

Jarische Frances S. Lao-Ang, MD, Ma. Lourdes Nebrida-Idea, MD, FPDS; and Ma. Lorna F. Frez, MD, FPDS

Abstract

Introduction:

Sneddon-Wilkinson disease (SWD) is a rare, recurrent neutrophilic dermatosis presenting as sterile pustules, with a predilection for flexural and intertriginous areas.

 

Case:

A 49-year-old Filipino female presented with a three-year history of recurrent pustules and papules on the flexural areas of trunk and extremities. Skin punch biopsy was done and histopathology was consistent with subcorneal pustular dermatosis/SWD. She was started on Dapsone but after two weeks of intake, the patient developed generalized erythematous desquamating plaques on the trunk and extremities, with palmoplantar involvement. The patient did not have fever, jaundice, lymphadenopathy, and abdominal tenderness. Laboratory investigation such as complete blood count and liver function tests were normal. The final diagnosis was SWD with hypersensitivity to Dapsone. Dapsone was immediately discontinued and she was shifted to oral colchicine. After six weeks of oral colchicine therapy, the lesions have completely resolved. Patient was in remission for six months thereafter.

 

Conclusion:

SWD is rare and the drug of choice is dapsone. In instances where dapsone is not suitable, oral colchicine can be an ideal alternative treatment.

References

  1. Watts, P. and Khachemoune, A. (2016). Review Article: Subcorneal Pustular Dermatosis: A Review of 30 Years of Progress. Am J Clin Dermatology Dec; 17(6):653-671.
  2. Philippine Dermatologic Society Health Information System data. Retrieved: February 2018
  3. Cheng S, Edmonds E, Ben-Gashir M, Yu RC. Subcorneal pustular dermatosis: 50 years on Clin Exp Dermatol 2008;33:229.
  4. Razera F, Olm GS, Bonamigo RR. Neutrophilic dermatoses: part II. An Bras Dermatol. 2011;86(2):195–209
  5. Kasha EE, Epinette WW. Subcorneal pustular dermatosis in association with a monoclonal IgA gammopathy. A report and review of the literature. J Am Acad Dermatol 1988;19:854
  6. Lipe,B., and Kyle,R. (2016) Monoclonal Gammopathy of Undetermined Significance (MGUS): Predictor of Progression and Monitoring. Downloaded from: http://www.hematology.org/Guidelines-Quality/Quick-Ref/6973.aspx
  7. Cohen PR. Neutrophilic dermatoses: a review of current treatment options. Am J Clin Dermatol. 2009;10(5):301–12
  8. Lorenz,M., Wozel,G. and Schmitt,J. Hypersensitivity reactions to Dapsone: a review article. Acta Derm Venereology 2012; 92:194-199
  9. Pavithran K. Colchicine in the treatment of subcorneal pustular dermatosis. Indian J Dermatol Venereol Leprol 1995;61:56-7
  10. Laifaoui JA, Guillen E, Worret WI, Ring J. A case of subcorneal pustular dermatosis (Sneddon-Wilkinson disease) not responding to dapsone: Therapeutic alternatives. Acta Dermatoven APA 2003;12:109.

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A case of Sneddon-Wilkinson disease with hypersensitivity to dapsone successfully managed with colchicine (SLMC)