Overview of Sulfonamides and Related Medications: Query if Mesalamine should be Preferred Over Dapsone and Sulfasalazine

Sulfonamide research led to the discovery of dapsone and sulfasalzine. Both of these latter drugs have found a niche in the dermatological armamentarium especially for treatment of numerous non-infectious, inflammatory, autoimmune, and bullous disesases. These drugs, however, have side effects which include toxic hepatitis, neuropathy, cholestatic jaundice, hemolysis and methemoglobinemia. In the case of sulfasalamine, it is a conjugate of mesalamine and sulfapyridine. Of note, the latter moiety, sulfapyridine, is no longer available for human use as a separate drug due to side effects. In regards again with sulfasalazine, a pharmacology textbook credits mesalamine to be the major therapeutic moiety, while sulfapyridine is the culprit of the most significant adverse effects. There has been a suggestion in the literature that mesalamine may be the preferred agent for some of these dermatologic therapies for which Dapsone and sulfasalazine are presently suggested. A major impetus to seek this alternate therapy would be its more favorable side effect profile. Certainly more clinical studies using mesalamine are warranted to attest to its clinical effectiveness in relation to the two more established alternatives.