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[ 222, 223 Patients with both types of IgA pemphigus clinically show with flaccid vesicles or pustules or both on erythematous or usual skin. Pruritus is a meaningful symptom that may interfere with the patient's daily activities. Dapsone has proved to be the drug of choice in the treatment of IgA pemphigus. [ 219, 220, 221, 224, 225 Therapeutic alternatives in cases in which dapsone is not able-bodied tolerated, or its thing are inadequate or transient, comprehend systemic or topical steroids, PUVA, retinoids and several combinations of these. Though all of these are second-line treatments, while dapsone remains the drug of choice. Pyoderma gangrenosum Although the opinion that pyoderma gangrenosum was an infectious case has fallen into disfavour, sure antimicrobial agents accept been tried and much begin to be acknowledged in treating the disease.[ 226 Their means of activity is clearly not related to their antibacterial aftereffect, however rather to an anti-inflammatory, immunomodulating aftereffect. Sulfa drugs accept been one of the most commonly used agents in the treatment of pyoderma gangrenosum. Sulfasalazine, a sulfonamide whose leading employ is for treating inflammatory bowel disease, was the aboriginal sulfa drug to be tried for alleviating pyoderma gangrenosum. It was initially reported in 1957 to be benign in the treatment of nine of twelve patients with pyoderma gangrenosum and proved to be able much in patients without underlying inflammatory bowel disease. [ 227 As sulfasalazine is metabolized in the intestine to sulfapyridine and 5 aminosalicylate, distinct researchers tried sulfapyridine alone and reported accomplishment in distinct cases of pyoderma gangrenosum. [ 227, 228, 229, 230 In some of them, the response to sulfapyridine was seen after failure with sulfasalazine, maybe as of the higher blood levels that can be achieved with the former. The aboriginal report of the acknowledged treatment of pyoderma gangrenosum with a derivative of dapsone appeared in 1962 with a report of four patients that responded favourably to this therapy.[ 229 Subsequently, distinct other authors reported on the acknowledged treatment of pyoderma gangrenosum with dapsone alone [ 231, 232 and in combination with spoken [ 233, 234 , intravenous [ 235 , or intralesional steroids. [ 236 All told, there are alone a too hardly any reports on the efficacy of dapsone in the treatment of pyoderma gangrenosum, and all of them call unmarried cases or local position series (i. e., a maximum of 4 patients). This may be due to the rarity of the disease, estimated at 3 cases per 1 million populations per year. But, we suspect that the absolute ground is probably the unconvincing outcomes of this therapy combined with the mind of investigators to report mostly absolute results. Although currently available treatment for pyoderma gangrenosum is far from passable, we cannot reccomend the employ of dapsone until added information on this therapy are available. Malignant pyoderma, which was described as a fresh disease object in 1968 is immediately considered a subtype of pyoderma gangrenosum [ 237, 238 . Generally, malignant pyoderma responds able-bodied to corticosteroid therapy, however relapses action when the dose is gradually lowered. 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[ 242, 243 Because then, distinct other reports confirmed the benign thing of dapsone in controlling the disease, [ 244, 245, 246, 247, 248, 249, 250, 251, 252 although the familiarity of other authors with dapsone alone or in combination with steroids was disappointing. [ 249, 253, 254, 255, 256, 257 The rarity of relapsing polychondritis, the diversity of its presentation, and the unpredictable recurrence percentage are all factors that preclude randomized controlled therapeutic clinical trials, critical test of the efficacy of dapsone and the establishment of a standardized therapeutic protocol. Although the epitome treatment for relapsing polychondritis has not even been begin, the available evidence indicates that dapsone and/or systemic corticosteroids are the most able therapies, with neither showing meaningful service over the other. Spider bites

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