|
Drug |
Dosage |
Adverse effects |
Special considerations |
|
Superpotent topical glucocorticoids (0.05% clobetasol propionate cream or ointment) |
Topically on affected areas once daily or bid |
– Skin atrophy – Acne – Purpura – Hypertrichosis – Hypopigmentation |
Should be avoided if there is extensive BSA involvement (>10%) due to risk of systemic absorption. Should not be used continuously for >3 weeks |
|
Systemic glucocorticoids (prednisone) |
Prednisone 0.5-1 mg/kg/d PO until full resolution of itching and blisters, then tapered down slowly over a few months |
– Hyperglycemia – Hypertension – Peripheral edema – Osteoporosis – Myopathy – Cataracts – Glaucoma – Peptic ulcer disease – Leukocytosis – Neutrophilia – Lymphopenia – Insomnia – Irritability – Mood changes |
|
|
Tetracycline antibiotics (tetracycline, minocycline, doxycycline) |
Tetracycline 500 mg PO qid or minocycline 100 mg PO bid, or doxycycline 100 mg PO bid |
– GI upset – Photosensitivity – Drug-induced lupus with minocycline |
Can be given with or without nicotinamide (vitamin B3). Nicotinamide is an over-the-counter product and has been used at doses of 500-2000 mg/d due to a possible anti-inflammatory effect |
|
Azathioprine |
TPMT level must be checked prior to therapy initiation. The maximum doses are 2 mg/kg/d (TPMT >19 U), 1-1.5 mg/kg/d (TPMT, 13.7-19 U), and 0.5 mg/kg (TPMT, 5-13.7 U) |
– GI upset – Myelosuppression – Immunosuppression – Increased risk of infection – Increased risk of cancers including nonmelanoma skin cancers – Pancreatitis |
Requires follow-up monitoring of CBC, liver and kidney function tests |
|
MMP or MPA |
1-3 g/d (MMP) or 360-1080 mg bid (MPA) |
– GI upset – Myelosuppression – Immunosuppression – Increased risk of infection – Increased risk of cancers – Sterile pyuria – Dizziness |
Requires follow-up monitoring of CBC, liver and kidney function tests |
|
Methotrexate |
7.5-20 mg/wk PO or SC |
– Nausea, vomiting, and GI upset – Fatigue – Leukopenia – Alopecia – Mucositis – Elevated liver enzymes – Pneumonitis |
Requires follow-up monitoring of CBC, liver and kidney function tests |
|
Dapsone |
G6PD levels should be checked prior to initiating dapsone. The dose ranges from 25 to 100 mg/d PO |
– Hemolytic anemia – Methemoglobinemia – Agranulocytosis – Hypersensitivity reaction – Peripheral neuropathy |
|
|
IVIG |
2-3 g/kg every 4 weeks |
– Transfusion reactions – Transfusion-associated circulatory overload – Anaphylaxis in IgA-deficient patients |
– Very expensive – Premedication with acetaminophen (INN paracetamol) and antihistamines may prevent transfusion reaction or reduce its severity |
|
Rituximab |
375 mg/m2/wk IV × 4 doses or 1 g IV on days 0 and 15 |
– Infusion reactions (fever, headache, nausea, and pruritus) within the initial 0.5-2 h of the first infusion |
Premedication with acetaminophen (INN paracetamol) and antihistamines, usually with glucocorticoids PO, is commonly used to prevent infusion reactions |
|
BSA, body surface area; CBC, complete blood count; GI, gastrointestinal; G6PD, glucose-6-phosphate dehydrogenase; INN, international nonproprietary name; IVIG, intravenous immunoglobulin; MMP, mycophenolate mofetil; MPA, mycophenolic acid; PO, oral; SC, subcutaneous; TPMT, thiopurine methyltransferase. | |||