Skip to main content
PMC home page
The British Journal of Ophthalmology logoLink to The British Journal of Ophthalmology
. 1996 Jun;80(6):549–552. doi: 10.1136/bjo.80.6.549

Sulphapyridine--a new agent for the treatment of ocular cicatricial pemphigoid.

M J Elder 1, J Leonard 1, J K Dart 1
PMCID: PMC505530  PMID: 8759268

Abstract

AIMS--Ocular cicatricial pemphigoid (OCP) is a severe, potentially sight threatening systemic disease that sometimes requires systemic immunosuppression. This study assessed the clinical outcome of patients with OCP treated with sulphapyridine, a sulphonamide with an anti-inflammatory and immunosuppressive action but few side effects. METHODS--A prospective, single armed, unmasked clinical trial was undertaken at Moorfields Eye Hospital. Twenty consecutive patients with moderate or marked conjunctival inflammation due to OCP were treated with oral sulphapyridine 500 mg twice daily. The degree of ocular inflammation was assessed as nil, mild, moderate, marked, or severe. Success was defined as resolution to mild or less. Ocular limbitis, systemic features of the disease, and side effects of the drug were also monitored. RESULTS--Follow up was a mean of 12.3 (SD 4.0) months and ranged from 7 to 17 months. A successful reduction in inflammation was recorded in 22/39 eyes (56%) and 10/20 patients (50%). This improvement occurred within 1 month in 64% and in all by 2 months. Three patients developed allergy. Other side effects included nausea (n = 3), headache (n = 1), urinary hesitancy (n = 1), and mild lymphocytopenia (n = 1). These were dose dependent. Progression of cicatrisation was observed in 1/22 eyes. Success was less likely if there were systemic features of OCP or ocular limbitis. CONCLUSIONS--Sulphapyridine was clinically effective in 50% of patients with moderate marked inflammation and had few side effects. It is a good alternative to dapsone.

Full text

PDF
549

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDREWS G. C., DOMONKOS A. N., POST C. F. Treatment of acne vulgaris. J Am Med Assoc. 1951 Jul 21;146(12):1107–1113. doi: 10.1001/jama.1951.03670120017005. [DOI] [PubMed] [Google Scholar]
  2. Ashworth M., Arthur M., Turmer A. D., Smith P. R. A comparison of serum concentrations of sulphasalazine and some of its metabolites after therapy by the oral or rectal route. Pharmatherapeutica. 1984;3(8):551–555. [PubMed] [Google Scholar]
  3. BURNS R. E., FINE G. Subcorneal pustular dermatosis. AMA Arch Derm. 1959 Jul;80(1):72–80. doi: 10.1001/archderm.1959.01560190074011. [DOI] [PubMed] [Google Scholar]
  4. Boitard C., Bach J. F. Long-term complications of conventional immunosuppressive treatment. Adv Nephrol Necker Hosp. 1989;18:335–354. [PubMed] [Google Scholar]
  5. Booth S. A., Moody C. E., Dahl M. V., Herron M. J., Nelson R. D. Dapsone suppresses integrin-mediated neutrophil adherence function. J Invest Dermatol. 1992 Feb;98(2):135–140. doi: 10.1111/1523-1747.ep12555654. [DOI] [PubMed] [Google Scholar]
  6. Cowan G. O., Das K. M., Eastwood M. A. Further studies of sulphasalazine metabolism in the treatment of ulcerative colitis. Br Med J. 1977 Oct 22;2(6094):1057–1059. doi: 10.1136/bmj.2.6094.1057. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Crotty B., Jewell D. P. Drug therapy of ulcerative colitis. Br J Clin Pharmacol. 1992 Sep;34(3):189–198. doi: 10.1111/j.1365-2125.1992.tb04124.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Dabrowski J., Jablońska S., Chorzelski T. P., Jarzabek-Chorzelska M., Maciejewski W. Electron microscopic studies in dermatitis herpetiformis in relation to the pattern of immune deposits in the skin. Arch Dermatol Res. 1977 Sep 27;259(3):213–224. doi: 10.1007/BF00561449. [DOI] [PubMed] [Google Scholar]
  9. Dantzig P. I. Immunosuppressive and cytotoxic drugs in dermatology. Arch Dermatol. 1974 Sep;110(3):393–406. [PubMed] [Google Scholar]
  10. Foster C. S. Cicatricial pemphigoid. Trans Am Ophthalmol Soc. 1986;84:527–663. [PMC free article] [PubMed] [Google Scholar]
  11. Foster C. S., Wilson L. A., Ekins M. B. Immunosuppressive therapy for progressive ocular cicatricial pemphigoid. Ophthalmology. 1982 Apr;89(4):340–353. doi: 10.1016/s0161-6420(82)34791-0. [DOI] [PubMed] [Google Scholar]
  12. Francis I. C., McCluskey P. J., Walls R. S., Wakefield D., Brewer J. M. Ocular cicatricial pemphigoid. Aust N Z J Ophthalmol. 1990 May;18(2):143–150. doi: 10.1111/j.1442-9071.1990.tb00605.x. [DOI] [PubMed] [Google Scholar]
  13. Gibson P. R., Jewell D. P. Sulphasalazine and derivatives, natural killer activity and ulcerative colitis. Clin Sci (Lond) 1985 Aug;69(2):177–184. doi: 10.1042/cs0690177. [DOI] [PubMed] [Google Scholar]
  14. Hardy K. M., Perry H. O., Pingree G. C., Kirby T. J., Jr Benign mucous membrane pemphigoid. Arch Dermatol. 1971 Nov;104(5):467–475. [PubMed] [Google Scholar]
  15. Hawthorne A. B., Hawkey C. J. Immunosuppressive drugs in inflammatory bowel disease. A review of their mechanisms of efficacy and place in therapy. Drugs. 1989 Aug;38(2):267–288. doi: 10.2165/00003495-198938020-00007. [DOI] [PubMed] [Google Scholar]
  16. Hoult J. R. Pharmacological and biochemical actions of sulphasalazine. Drugs. 1986;32 (Suppl 1):18–26. doi: 10.2165/00003495-198600321-00005. [DOI] [PubMed] [Google Scholar]
  17. Klotz U. Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid. Clin Pharmacokinet. 1985 Jul-Aug;10(4):285–302. doi: 10.2165/00003088-198510040-00001. [DOI] [PubMed] [Google Scholar]
  18. Lang P. G., Jr Sulfones and sulfonamides in dermatology today. J Am Acad Dermatol. 1979 Dec;1(6):479–492. doi: 10.1016/s0190-9622(79)80088-2. [DOI] [PubMed] [Google Scholar]
  19. McFadden J. P., Leonard J. N., Powles A. V., Rutman A. J., Fry L. Sulphamethoxypyridazine for dermatitis herpetiformis, linear IgA disease and cicatricial pemphigoid. Br J Dermatol. 1989 Dec;121(6):759–762. doi: 10.1111/j.1365-2133.1989.tb08218.x. [DOI] [PubMed] [Google Scholar]
  20. Molin L., Larsson R., Karlsson E. Evaluation of the sulphapyridine acetylator phenotyping test in healthy subjects and in patients with cardiac and renal diseases. Acta Med Scand. 1977;201(3):217–222. doi: 10.1111/j.0954-6820.1977.tb15685.x. [DOI] [PubMed] [Google Scholar]
  21. Mondino B. J., Brown S. I. Immunosuppressive therapy in ocular cicatricial pemphigoid. Am J Ophthalmol. 1983 Oct;96(4):453–459. doi: 10.1016/s0002-9394(14)77908-5. [DOI] [PubMed] [Google Scholar]
  22. Mondino B. J., Brown S. I., Lempert S., Jenkins M. S. The acute manifestations of ocular cicatricial pemphigoid: diagnosis and treatment. Ophthalmology. 1979 Apr;86(4):543–555. doi: 10.1016/s0161-6420(79)35486-0. [DOI] [PubMed] [Google Scholar]
  23. Mondino B. J., Brown S. I. Ocular cicatricial pemphigoid. Ophthalmology. 1981 Feb;88(2):95–100. doi: 10.1016/s0161-6420(81)35069-6. [DOI] [PubMed] [Google Scholar]
  24. Mondino B. J. Cicatricial pemphigoid and erythema multiforme. Ophthalmology. 1990 Jul;97(7):939–952. doi: 10.1016/s0161-6420(90)32479-x. [DOI] [PubMed] [Google Scholar]
  25. Mondino B. J., Ross A. N., Rabin B. S., Brown S. I. Autoimmune phenomena in ocular cicatricial pemphigoid. Am J Ophthalmol. 1977 Apr;83(4):443–450. doi: 10.1016/0002-9394(77)90546-3. [DOI] [PubMed] [Google Scholar]
  26. Neumann V. C., Taggart A. J., Le Gallez P., Astbury C., Hill J., Bird H. A. A study to determine the active moiety of sulphasalazine in rheumatoid arthritis. J Rheumatol. 1986 Apr;13(2):285–287. [PubMed] [Google Scholar]
  27. PERRY H. O., BRUNSTING L. A. Pyoderma gangrenosum; a clinical study of nineteen cases. AMA Arch Derm. 1957 Mar;75(3):380–386. doi: 10.1001/archderm.1957.01550150066007. [DOI] [PubMed] [Google Scholar]
  28. Panayiotou B. N. Pulmonary infiltrates and eosinophilia associated with sulphasalazine administration. Aust N Z J Med. 1991 Jun;21(3):348–349. doi: 10.1111/j.1445-5994.1991.tb04705.x. [DOI] [PubMed] [Google Scholar]
  29. Person J. R., Rogers R. S., 3rd Bullous pemphigoid responding to sulfapyridine and the sulfones. Arch Dermatol. 1977 May;113(5):610–615. [PubMed] [Google Scholar]
  30. Pullar T., Hunter J. A., Capell H. A. Sulphasalazine in the treatment of rheumatoid arthritis: relationship of dose and serum levels to efficacy. Br J Rheumatol. 1985 Aug;24(3):269–276. doi: 10.1093/rheumatology/24.3.269. [DOI] [PubMed] [Google Scholar]
  31. Pullar T., Hunter J. A., Capell H. A. Which component of sulphasalazine is active in rheumatoid arthritis? Br Med J (Clin Res Ed) 1985 May 25;290(6481):1535–1538. doi: 10.1136/bmj.290.6481.1535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Punchard N. A., Boswell D. J., Greenfield S. M., Thompson R. P. The effects of sulphasalazine and its metabolites on prostaglandin production by human mononuclear cells. Biochem Pharmacol. 1992 Jun 9;43(11):2369–2376. doi: 10.1016/0006-2952(92)90315-a. [DOI] [PubMed] [Google Scholar]
  33. Rogers R. S., 3rd, Seehafer J. R., Perry H. O. Treatment of cicatricial (benign mucous membrane) pemphigoid with dapsone. J Am Acad Dermatol. 1982 Feb;6(2):215–223. doi: 10.1016/s0190-9622(82)70014-3. [DOI] [PubMed] [Google Scholar]
  34. Schwab I. R., Linberg J. V., Gioia V. M., Benson W. H., Chao G. M. Foreshortening of the inferior conjunctival fornix associated with chronic glaucoma medications. Ophthalmology. 1992 Feb;99(2):197–202. doi: 10.1016/s0161-6420(92)32001-9. [DOI] [PubMed] [Google Scholar]
  35. TRUELOVE S. C., WATKINSON G., DRAPER G. Comparison of corticosteroid and sulphasalazine therapy in ulcerative colitis. Br Med J. 1962 Dec 29;2(5321):1708–1711. doi: 10.1136/bmj.2.5321.1708. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Taggart A. J., Neumann V. C., Hill J., Astbury C., Le Gallez P., Dixon J. S. 5-Aminosalicylic acid or sulphapyridine. Which is the active moiety of sulphasalazine in rheumatoid arthritis? Drugs. 1986;32 (Suppl 1):27–34. doi: 10.2165/00003495-198600321-00006. [DOI] [PubMed] [Google Scholar]
  37. Tauber J., Sainz de la Maza M., Foster C. S. Systemic chemotherapy for ocular cicatricial pemphigoid. Cornea. 1991 May;10(3):185–195. doi: 10.1097/00003226-199105000-00001. [DOI] [PubMed] [Google Scholar]
  38. Venning V. A., Millard P. R., Wojnarowska F. Dapsone as first line therapy for bullous pemphigoid. Br J Dermatol. 1989 Jan;120(1):83–92. doi: 10.1111/j.1365-2133.1989.tb07769.x. [DOI] [PubMed] [Google Scholar]
  39. Vollum D. I. Erythema elevatum diutinum--vesicular lesions and sulphone response. Br J Dermatol. 1968 Mar;80(3):178–183. doi: 10.1111/j.1365-2133.1968.tb12289.x. [DOI] [PubMed] [Google Scholar]
  40. WINKELMANN R. K., ROTH H. L. Dermatitis herpetiformis with acantholysis or pemphigus with response to sulfonamides: report of two cases. Arch Dermatol. 1960 Sep;82:385–390. doi: 10.1001/archderm.1960.01580030079010. [DOI] [PubMed] [Google Scholar]
  41. Wells G. C. Allergic vasculitis(tri-symptom of Gougerot) treated with dapsone. Proc R Soc Med. 1969 Jul 7;62(7):665–666. [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of Ophthalmology are provided here courtesy of BMJ Publishing Group

RESOURCES