Use of Sulfasalazine in Dermatitis Herpetiformis in Young People

To the Editor.—  It is common practice in dermatology to treat patients suspected of having dermatitis herpetiformis with sulfapyridine or with a sulfone. While these drugs are often effective, they have many well-known toxic effects. It would be especially desirable to avoid their use in young people with dermatitis herpetiformis, who face a long period of cumulative exposure to these agents and their toxicities.Sulfasalazine (Azulfidine) has been reported^1-5 to be effective in treating dermatitis herpetiformis. It is widely used in treatment of ulcerative colitis, and, to a lesser extent, of pyoderma gangrenosum and livedoid vasculitis.Although it is apparently converted to sulfapyridine, and is well known to cause severe and even fatal reactions, it appears that the frequency of serious side effects (other than nausea and vomiting) is much lower with sulfasalazine than with sulfapyridine or the sulfones. This is a clinical impression I cannot confirm by hard