Heparin-Induced Thrombocytopenia Presenting as Bilateral Adrenal Hemorrhages

Drug Administration in 2005 as a topical 5% gel (50 mg of dapsone per 1 g of product; Aczone, Allergan).After the topical application of dapsone gel, a plasma level is detectable within 2 hours and has a half-life of 48 hours. 2 Our patient had been applying a pea-sized amount of topical dapsone twice daily for 7 days before presentation.Details of the mechanism of dapsone-induced methemoglobinemia and a discussion of other possible contributing factors in this patient's case are provided in the Supplementary Appendix, available with the full text of this letter at NEJM.org.Our case report highlights the potential for systemic absorption with clinical methemoglobinemia after prescribed therapeutic use of a topical dapsone-containing product.