From the Research
The best management approach for Sweet's syndrome involves systemic corticosteroids as first-line therapy, typically prednisone at 0.5-1 mg/kg/day for 4-6 weeks with a gradual taper, as supported by the most recent and highest quality study 1.
Key Considerations
- Treatment should begin promptly after diagnosis to provide rapid symptom relief.
- For mild cases, potent topical corticosteroids may be sufficient.
- In steroid-resistant cases or when steroid-sparing is needed, alternative options include colchicine (0.5 mg 2-3 times daily), dapsone (100-200 mg daily), potassium iodide (300-900 mg daily), or immunosuppressants like cyclosporine.
- Any underlying cause, particularly malignancy or infection, must be addressed simultaneously as this can lead to resolution of Sweet's syndrome.
- NSAIDs may help with symptomatic relief of pain and fever but are generally not sufficient as monotherapy.
Treatment Response and Recurrence
- Treatment response is typically rapid, with fever resolving within 72 hours and skin lesions improving within 1-2 weeks.
- Recurrence occurs in about 30% of cases, requiring maintenance therapy in some patients.
- This approach targets the neutrophilic inflammation characteristic of Sweet's syndrome, reducing the inflammatory cytokines that drive the condition, as discussed in 1 and supported by earlier studies like 2 and 3.
Special Considerations
- In cases associated with inflammatory bowel disease, as discussed in 4, corticosteroids and anti-tumour necrosis factor (TNF)-α inhibitor therapy have demonstrated efficacy.
- Azathioprine-associated Sweet's syndrome presents and behaves distinctly, especially with regard to gender, age at diagnosis, and recurrence risk, highlighting the need for personalized treatment approaches based on the underlying cause of Sweet's syndrome.