Allopurinol

Allopurinol is a xanthine oxidase inhibitor used in the treatment of gout and some inflammatory diseases. Its anti-inflammatory capabilities are the basis for its use in cutaneous sarcoidosis.

Benefits

No systematic reviews or RCTs describing the use of allopurinol for treatment of cutaneous sarcoidosis were found. One non-randomised non-controlled open prospective study of six patients with cutaneous sarcoidosis reported treatment with allopurinol, 100 mg/day, increased by 100 mg every 2-4 weeks to 600 mg/day. Four of the six patients in the initial report had improvement of their lesions.54

Additional information was found in several case reports. Pfau et al.55 treated two patients with scar sarcoidosis and two patients with nodular sarcoidosis with allopurinol 300 mg/day over a 3-7-month period. Lesions completely resolved in the patients with scar sarcoidosis and partially resolved in the patients with nodular sarcoidosis. Rosof et al.56 observed remission of cutaneous sarcoidosis in two patients treated with allopurinol. Pollock57 reported on two patients with cutaneous sarcoidosis; one treated with allopurinol, 100 mg/day, and the other with 300 mg/day; both patients experienced marked improvement in their lesions. Brechtel et al.58 reported on a patient who had disseminated cutaneous sarcoidosis refractory to chloroquine treatment that responded to allopurinol, 300 mg/day. Voelter-Mahlknect et al59 observed a patient with subcutaneous sarcoidosis who was treated with allopurinol, 200 mg/day (later increased to 600 mg/day). Allopurinol failed, and the patient's lesions actually progressed. Antony et al.60 reported on a case of cutaneous acral sarcoidosis unresponsive to other therapies that responded to allopurinol, 300 mg/day.

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