Dapsone as an effective treatment for arthritis secondary to hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a disorder of the terminal follicular epithelium in the apocrine sweat glands. Chronic relapsing inflammation, mucopurulent discharge, and progressive scarring frequently involving the axillary and inguinoperineal area characterize HS. Reactive arthritis is associated with chronic infections, such as HS, although joint involvement is uncommon. Treatment is based on the eradication of the underling infection. Whereas skin lesions may improve with antibiotic therapy, the arthritis of HS is often unresponsive to therapy. Various therapies have been tried in HS, including nonsteroidal antiinflammatory drugs, colchicine, mesalamine, dapsone, and TNF inhibitors. A case of severe, debilitating arthritis associated with HS that responded to dapsone is reported. This case demonstrates the difficulty of successful treatment of HS as well as of the associated arthritis.