Sir.—In reference to the article "Bullous Disease of Childhood" by Ramsdell et al (Journal 133:791-794, 1979), please correct an error. Fifty milligrams of dapsone twice daily is not the correct dosage for the treatment of bullous disease of childhood (or any other disease of childhood). Childhood weight varies from about 2 to 80 kg. Because the common side effects of dapsone, namely, methemoglobinemia and hemolysis, are usually dose-related, the dosage of this drug should be calculated on a body-weight basis. The authors' use of 250 mg of dapsone per day in the treatment of their first patient, an 18- to 20-month-old child, seems excessive to me; later the dosage was lowered.
The dosage recommended to one of the authors by me as early as 19761 is 2 mg/kg. The dangers of a larger dosage were pointed out to me in conversation with R. Caputo, MD (Jan 11, 1979). He
KAHN G. The Danger of 50-mg Dapsone Doses to Children. Am J Dis Child. 1980;134(6):623. doi:10.1001/archpedi.1980.02130180079025