9 Dapsone Side Effects You Should Know About

Dapsone is a sulfone antibiotic that treats certain types of skin conditions. It’s available as a topical gel (Aczone) in two different concentrations for acne. It’s also available as an oral tablet to treat leprosy and a skin rash called dermatitis herpetiformis that’s often connected to celiac disease.

Whether you’re applying it topically or taking oral tablets, dapsone may cause side effects. Unlike other antibiotics, you may take dapsone long term (months to years). So it’s helpful to know what to expect and how to manage side effects if they appear during treatment.

Dapsone side effects at a glance

Below is a list of common and serious dapsone side effects reported in clinical studies. Keep in mind that you may experience a side effect that’s not listed here. So it’s best to talk to a healthcare professional about any unexpected or worrisome symptoms you experience during dapsone treatment.

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Common side effects of topical dapsone:

• Red skin

• Dry skin

• Oily, peeling skin

• Itching or burning sensation

Common side effects of oral dapsone:

• Nausea or vomiting

• Stomach pain

• Headache

• Small decrease in red blood cell counts (may lead to feeling tired or weak)

Rare but serious dapsone side effects (more likely with oral treatment):

• Blue lips, mouth, or fingernails

• Numbness in the hands or feet

• Muscle weakness

• Low blood cell counts

• Increased risk of infection

• Liver problems

• Severe skin reactions

• Pancreatitis

• Fast heart beat

• Mood changes

• Lung problems

• Kidney problems

Let’s take a closer look at nine dapsone side effects and how you can manage them.

1. Red skin

Dapsone gel can cause red, irritated skin — especially in the beginning of treatment. It usually gets better over time as your skin gets used to the medication. While this side effect can be frustrating, it’s not likely to be harmful. Keeping the amount of dapsone you’re applying as small as possible and only using it on acne-prone areas can help minimize redness. 

While you may be tempted to cover redness with makeup, keep in mind this can further irritate your skin. So it’s best to wait for this side effect to go away on its own. In the meantime, be sure to use sunscreen and protect your skin from the sun, as it can make redness worse.

If redness worsens or becomes painful, reach out to your prescriber for guidance.

2. Dry skin

Another common side effect of dapsone gel is dry, flaky skin. This should also go away over time as your body becomes used to the medication.

A good daily skincare routine is essential for tackling dry skin. Be sure to choose a moisturizer that is non-comedogenic, meaning it won’t clog pores. You may also want to consider using a hypoallergenic, fragrance-free moisturizer to minimize irritation.

It may be tempting to peel, pick, or scrub away dry skin, but this isn’t recommended. It can worsen irritation and increase your chance of an infection. But if dry skin doesn’t improve on its own, let your prescriber know. You may need a gentler acne treatment.

3. Oily, peeling skin

Similar to dryness, some people experience oily, peeling skin as a topical dapsone side effect. In most cases, as with other skin-related side effects, this gets better as your skin adjusts to the medication. 

A mild cleanser that isn’t abrasive can help manage oiliness without drying out your skin. Moisturizer can also help, just make sure it’s not too heavy, as that can make oiliness worse.

If the peeling doesn’t go away or becomes painful, talk to your prescriber. If you’re using the higher concentration of dapsone gel (7.5%), they may recommend switching to the lower concentration (5%). Or they may recommend a different acne treatment altogether.

4. Itching or burning sensation

Itching or burning skin are also possible dapsone gel side effects, but they’re less common overall. Both typically get better as your skin gets used to the medication. As with redness, minimizing the amount of dapsone you’re applying can help lessen irritation. And proper skin care using a gentle cleanser along with daily moisturizer and sunscreen is key.

If at any point the discomfort becomes severe or worsens, stop using dapsone gel and reach out to your prescriber. They can make adjustments to your treatment to minimize your symptoms.

5. Nausea and vomiting

Many people experience nausea or vomiting when taking dapsone tablets. Some people also experience stomach pain.

Taking dapsone with food or milk can help prevent or lessen an upset stomach. Other things you can do include:

• Staying hydrated

• Avoiding spicy or fried foods that can worsen nausea

• Eating smaller, more frequent meals

If these changes don’t help, talk to your healthcare team about taking nausea medication. But don’t stop taking dapsone without talking to your prescriber first.

6. Blue lips, mouth, or fingernail beds

A blood condition called methemoglobinemia is a rare, but possible, dapsone side effect. It happens when the hemoglobin in your red blood cells can’t effectively provide oxygen to your body tissues. This can cause your lips, mouth, or fingernail beds to turn blue.

This side effect can happen with both topical and oral dapsone, although it’s less likely with dapsone gel. And it’s more common if you have a genetic change called glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD deficiency is more common in men from certain parts of Africa, Asia, and the Mediterranean.

Methemoglobinemia is a medical emergency that can be fatal if not treated. So seek medical care right away if you notice your mouth or fingernail beds turning blue at any point during dapsone treatment.

7. Numbness or tingling in the hands and feet

Numbness or tingling in the hands or feet (peripheral neuropathy) is a rare side effect of oral dapsone. But it can be serious, especially if you also develop muscle weakness. You may notice that you’re having trouble walking normally or performing fine motor skills.

If you’re taking dapsone for leprosy, it may be hard to tell if it’s the condition or the medication that’s causing your symptoms. Your prescriber can help determine the cause in this case.

It’s best to contact your prescriber at the first signs of this side effect. They may want to lower your dapsone dosage or stop treatment. In most cases, this side effect should go away after you stop taking dapsone.

8. Low blood cell counts

Low blood cell counts are another rare side effect of dapsone tablets. We’ve already mentioned methemoglobinemia, but you may also develop low levels of red blood cells, white blood cells, and platelets.

Low blood cell counts can raise your risk of infection. So let your healthcare team know if you develop a sore throat, fever, or cough while taking dapsone. Low platelet levels can also raise your risk of bleeding and cause reddish-brown spots called petechiae on your skin.

Your healthcare provider will likely run regular blood tests while you’re taking dapsone to keep an eye out for these side effects. But be sure to let them know if any of the above symptoms occur.

9. Severe skin reactions

Rarely, dapsone can cause severe skin reactions, such as Stevens-Johnson syndrome or toxic epidermal necrolysis. Severe skin reactions often start with flu-like symptoms. Then a rash appears a few days later and quickly progresses into blisters and peeling.

Severe skin reactions can be life threatening and require immediate medical attention. So it’s best to seek medical care for any rash that appears during dapsone treatment to be safe.

When should you seek medical care for dapsone side effects?

Any side effects that are bothersome or don’t improve are worth a call to your healthcare team. They can let you know if what you’re experiencing is normal or make changes to your medication if needed.

You should contact your prescriber right away if you notice numbness or tingling in your hands or feet or if you develop any sort of skin rash while taking dapsone. You should also let them know if you develop any signs or symptoms of an infection. 

If you notice a blue tint to your lips, mouth, or fingernails, seek emergency medical care.

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Written by:

Alex Evans, PharmD, MBA

Alex Evans, PharmD, MBA, has been a pharmacist for 12 years. His first job was floating in a community chain pharmacy.

Edited by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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