Journal de recherche clinique et expérimentale en dermatologie
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The Use of Dapsone as a Novel “Persister” Drug in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome

Richard I. Horowitz and Phyllis R. Freeman

Dapsone (diaminodiphenyl sulfone, i.e., DDS) is commonly used to treat dermatological conditions including acne, dermatitis herpetiformis, and leprosy. Mycobacterium leprae, a known "persister" bacteria, requires long-term treatment with intracellular medications including rifampin and Dapsone. Other "persister" bacteria recently have been identified, including Borrelia burgdorferi, the agent of Lyme disease.
Objectives: We tested the efficacy of DDS in patients with chronic Lyme disease/PTLDS with tick-borne coinfections including Babesiosis, who failed commonly used antibiotic and antimalarial protocols.
Methods: 100 patients with Lyme disease, 56 of who were Babesia positive, were placed on Dapsone and folic acid in combination with either one or two other intracellular drugs, including rifampin, tetracyclines, and/or macrolide antibiotics. Several patients also took cephalosporins, and all patients were on protocols to treat cystic forms of Borrelia and biofilms.
Results: Patients completed a symptom severity survey before beginning treatment with Dapsone and then again after at least one month of treatment scoring their complaints from 0 indicating “none” to 4 indicating “severe” for symptoms including fatigue, joint and/or muscle pain, disturbed sleep, and cognitive difficulties. Results demonstrated that Dapsone significantly improved all patients’ clinical symptoms except for headache, where changes did not reach statistical significance. In addition, Dapsone, known to have anti-malarial effects, helped resistant Babesia symptoms of sweats, chills, and flushing. Lyme positive, Babesia positive patients also demonstrated significant changes in pain, disturbed sleep, and cognitive difficulties. Side effects included macrocytic anemia and rare cases of methemoglobenemia, which resolved by either decreasing the dose of Dapsone or increasing folic acid.
Conclusion: Dapsone is a novel and effective “persister” drug for those with PTLDS and associated tick-borne co-infections who have failed classical antibiotic protocols. Further prospective trials must determine the DDS dose, length of treatment and best combination antibiotic therapy in order to effect a long-term health benefit.