**11. Treatment**

Nowadays, the first line therapies for SS are systemic corticosteroids, potassium iodide, and colchicine (Cohen, 2009). Systemic corticosteroids are the most widely used: the clinical response is so fast and brilliant that it is considered a diagnostic criterion (Su & Liu, 1986). The general malaise fades into hours and skin lesions into days (less than 10 days) (von den Driesch, 1994). Oral prednisone is given at a dosage of 0.5-1 mg/kg/day (in a single dose or divided in two doses). The dosage is progressively lowered during 3-6 weeks. Such brilliant response to prednisone is darken by the frequent recurrences: 20- 30% of the patients will suffer recurrences after treatment withdrawal and up to 10% of the cases will have a chronic and recurrent evolution for more than 1 year (Kemmett & Hunter, 1990; Sitjas et al, 1993, von den Driesch, 1994; Ginarte et al, 1997). The recurrences respond well to a new cycle of systemic corticosteroids (Ginarte et al, 1997), but their use is limited by their long-term side effects. Another limitation of systemic corticosteroids is the potential existence of an active infection that may trigger the SS. It is important to ruled out such possiblity.

Potassium iodide is a therapy as fast and effective as systemic corticosteroids. In fact, the response to this agent was included in the diagnostic criteria by von den Driesch (von den Driesch, 1994). Systemic symptoms disappear within 24 to 48 hours and cutaneous plaques in as much as 1 week. The dosage of potassium iodide is 300 mg administrated orally, three times daily (or if it is used the Lugol saturated solution, 3 drops three times each day and then increasing progressively the dose to a maximum of 15 drops three times each day). The main adverse effects are gastrointestinal intolerance (nausea and/or diarrhea), hypotiroidism, and vasculitis (Horio et al, 1983).

The other first-line therapy for SS is colchicine. This drug is administered at a dosage of 0.5 mg, two or three times per day. It can be maintained from 2 to 4 weeks. About 90% of the patients respond favorably within a few days and its main limitation are the gastrointestinal side effects (nausea and/or diarrhea) (Maillard et al, 1999).

There have been reported favorable responses to a wide and heterogeneous group of drugs. The response to several of these drugs is only based in isolated case reports, so it must be considered with caution. Table 6 summarized the drugs most repeatedly pointed out in the literature (isolated case reports are not included). These drugs are considered second-line treatments, but it is important to keep them in mind because they may be an effective therapy in patients with frequent recurrences, intolerance or adverse effects to the first-line treatments. This fact is especially applicable to elderly or polymedicated patients.

Obviously, although it was not mentioned, it is also important to treat the underlying process when possible.

Nowadays, the first line therapies for SS are systemic corticosteroids, potassium iodide, and colchicine (Cohen, 2009). Systemic corticosteroids are the most widely used: the clinical response is so fast and brilliant that it is considered a diagnostic criterion (Su & Liu, 1986). The general malaise fades into hours and skin lesions into days (less than 10 days) (von den Driesch, 1994). Oral prednisone is given at a dosage of 0.5-1 mg/kg/day (in a single dose or divided in two doses). The dosage is progressively lowered during 3-6 weeks. Such brilliant response to prednisone is darken by the frequent recurrences: 20- 30% of the patients will suffer recurrences after treatment withdrawal and up to 10% of the cases will have a chronic and recurrent evolution for more than 1 year (Kemmett & Hunter, 1990; Sitjas et al, 1993, von den Driesch, 1994; Ginarte et al, 1997). The recurrences respond well to a new cycle of systemic corticosteroids (Ginarte et al, 1997), but their use is limited by their long-term side effects. Another limitation of systemic corticosteroids is the potential existence of an active infection that may trigger the SS. It is important to

Potassium iodide is a therapy as fast and effective as systemic corticosteroids. In fact, the response to this agent was included in the diagnostic criteria by von den Driesch (von den Driesch, 1994). Systemic symptoms disappear within 24 to 48 hours and cutaneous plaques in as much as 1 week. The dosage of potassium iodide is 300 mg administrated orally, three times daily (or if it is used the Lugol saturated solution, 3 drops three times each day and then increasing progressively the dose to a maximum of 15 drops three times each day). The main adverse effects are gastrointestinal intolerance (nausea and/or diarrhea),

The other first-line therapy for SS is colchicine. This drug is administered at a dosage of 0.5 mg, two or three times per day. It can be maintained from 2 to 4 weeks. About 90% of the patients respond favorably within a few days and its main limitation are the gastrointestinal

There have been reported favorable responses to a wide and heterogeneous group of drugs. The response to several of these drugs is only based in isolated case reports, so it must be considered with caution. Table 6 summarized the drugs most repeatedly pointed out in the literature (isolated case reports are not included). These drugs are considered second-line treatments, but it is important to keep them in mind because they may be an effective therapy in patients with frequent recurrences, intolerance or adverse effects to the first-line treatments. This fact is especially applicable to elderly or polymedicated

Obviously, although it was not mentioned, it is also important to treat the underlying

1. Non-steroidal anti-inflammatory drugs: indometacin, naproxen

2. Tetracyclines: doxicycline, minocycline

Table 6. Second-line therapies of Sweet syndrome.

hypotiroidism, and vasculitis (Horio et al, 1983).

side effects (nausea and/or diarrhea) (Maillard et al, 1999).

3. Dapsone 4. Clofazimine 5. Cyclosporine

**11. Treatment** 

ruled out such possiblity.

patients.

process when possible.

#### **12. References**


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**Part 2** 

**Diagnostics & Prognostics** 

