From: MHKAY1@aol.com I have a middle aged woman with explosive Sweet's and no obvious underlying cause. Originally seen in the hospital on consult after 2 weeks of hospitalization for everything else her primary and specialist physicians could imagine, I biopsied and treated with prednisone. She cleared in short order but I cannot seem to take her off it completely. As all her tests have been otherwise negative I wonder how long to treat and are there reasonable alternatives. She gets massive total body bullous lesions. Any other evaluations I need to do? ===================== From: KSmithDerm@aol.com Sweet's - most of mine have done very well on dapsone 100 - 150 mg/day GA - responds well to PUVA =========================== From: Haines Ely In regard to these two patients: Be patient with them both.This type of bullous Sweets in my experience is associated with an underlying malignancy but it may not show up for several years. Places to look hardest:breast, thyroid, repeat cbc every 6 mos. I had a lady in the early 70's who had this type of bullous Sweets. I skin tested her to various bacterial antigens and could start the whole episode with strep pyogenes. I thought the bacterial peptidoglycan (superantigen) was responsible. Two years later she developed lymphoma. Similar story with another lady I presented at the PDA in 1984. After two years she came in with a breast nodule/Ca. One of my patients who goes insane on prednisone is fairly well controlled on tetracycline and indocin. After years of recurrent episodes she developed a malignant thyroid nodule. The story goes on and on but the similar thread is the ultimate appearance of cancer. ====================== From: "Rhett Drugge, M.D." Von den Driesch recently published an update of nonsteroidal treatment modalities for Sweet's syndrome on the Erlangen Dermatology Web Server (Table 1). This is an update on his review of 34 patients in the JAAD (REF1), and it was last updated, 5/17/95. It is an excellent, well-illustrate review of the subject (REF2). If anyone is having trouble access in the Web, to review such materials, please contact me. To view this table you must set your font to courier or another such font which delivers a common width per character. I would like to hear about the follow up on this patient. Rhett Drugge, M.D. TABLE 1 Drug Recommended initial dose Potassium iodide 900 mg/day Colchicine 1,5 mg/day Dapsone 100-200 mg/day Clofazimine 200 mg/day Cyclosporin A 5-10 mg/kg/ bodyweight/day Indomethacin 50-100 mg/day Naproxen 750 mg/day Doxycycline 200 mg/day REF1 von den Driesch P. Sweet's syndrome (acute febrile neutrophilic dermatosis). J Am Acad Dermatol 1994;31:535-556. REF2 http://www.rrze.uni-erlangen.de/docs/FAU/fakultaet/med/kli/derma/vorlesun/af nd/afnd.htm Rhett Drugge, M.D. ============================== From: Haines Ely The last patient I saw I gave a severe neuropathy with dapsone Rx of his Sweets. He was worked up by his internist and neurologist. They never called or asked me about his dx/rx. He came in today walking like a guy with tabes dorsalis. I asked what happened and he said after the big buck workup they didn't know the cause of his neuropathy. Needless to say the dapsone was stopped. I have the utmost respect for this drug and use it as little as possible. Haines Ely, Grass Valley, Ca. ============================= From: "Steven D. Emmet, M.D." i'd try trental one tab tid for both of them..if no luck, then erythro/tcn/colchicine/dapsone steve emmet ========================= From: Daniel F Mitchell Have you tried SSKI? Works fairly well for Sweet's. The SSKI may help to wean her off the Prednisone.