Etretinate and more recently acitretin have been used as successful alternatives. Combination chemotherapy for myeloma has been associated with clinical improvement. Other therapeutic modalities anecdotally recommended include colchicine, ketoconazole, and minocycline. Antibiotics - May have immunomodulatory effects. Dapsone is treatment of choice.
Response is slower than that with dermatitis herpetiformis.
Dose can be tapered to minimum required to maintain control. Not all patients respond, in which case sulfapyridine or sulfamethoxypyridazine can be tried. Retinoids - Decreases cohesiveness of abnormal hyperproliferative keratinocytes and may reduce potential for malignant degeneration. Modulate keratinocyte differentiation. Have been shown to reduce risk of skin cancer formation in renal transplant patients.