Dermatitis herpetiformis

Tetracycline plus nicotinamide

A handful of case reports support the use of tetracycline plus nicotinamide to treat patients with dermatitis herpetiformis in whom dapsone is not tolerated/ineffective.[2]Görög A, Antiga E, Caproni M, et al. S2k guidelines (consensus statement) for diagnosis and therapy of dermatitis herpetiformis initiated by the European Academy of Dermatology and Venereology (EADV). J Eur Acad Dermatol Venereol. 2021 Jun;35(6):1251-77. https://onlinelibrary.wiley.com/doi/10.1111/jdv.17183 http://www.ncbi.nlm.nih.gov/pubmed/34004067?tool=bestpractice.com [58]Shah SA, Ormerod AD. Dermatitis herpetiformis effectively treated with heparin, tetracycline and nicotinamide. Clin Exp Dermatol. 2000 May;25(3):204-5. http://www.ncbi.nlm.nih.gov/pubmed/10844495?tool=bestpractice.com [59]Zemtsov A, Neldner KH. Successful treatment of dermatitis herpetiformis with tetracycline and nicotinamide in a patient unable to tolerate dapsone. J Am Acad Dermatol. 1993 Mar;28(3):505-6. http://www.ncbi.nlm.nih.gov/pubmed/8445075?tool=bestpractice.com [60]Wang Y, Yang B, Zhou G, et al. Two cases of dermatitis herpetiformis successfully treated with tetracycline and niacinamide. Acta Dermatovenerol Croat. 2018 Oct;26(3):273-5. http://www.ncbi.nlm.nih.gov/pubmed/30390734?tool=bestpractice.com When used in combination, these drugs are thought to act by suppressing antibody formation and modulation of proinflammatory cytokines, and inhibition of inflammatory cell accumulation and T‑cell activation.[60]Wang Y, Yang B, Zhou G, et al. Two cases of dermatitis herpetiformis successfully treated with tetracycline and niacinamide. Acta Dermatovenerol Croat. 2018 Oct;26(3):273-5. http://www.ncbi.nlm.nih.gov/pubmed/30390734?tool=bestpractice.com This combination of drugs is contraindicated in children. Further research is required before this drug combination can be routinely recommended.