Treatment of alpha(1)-antitrypsin-deficiency panniculitis with minocycline

A small proportion of patients with alpha (1)-antitrypsin (alpha (1)AT) def iciency experience recurrent ulcerating panniculitis. Studies suggest that alpha (1)AT-deficiency panniculitis reflects an uncontrolled inflammatory p rocess because of the serum's incapacity to neutralize proteolytic enzymes released by leukocytes in the skin. Dapsone is considered the treatment of choice for this entity, but it is limited by its side effects, especially h ematologic ones. Tetracyclines have anticollagenase and anti-inflammatory a ctivity and have been used successfully to treat this type of panniculitis. We report the case of a 42-year-old woman with recurrent alpha (1)AT-defici ency panniculitis who did not tolerate the side effects of dapsone or syste mic corticosteroid. Minocycline treatment led to disappearance of lesions, and long-term administration prevented recurrences without evident negative side effects. We consider minocycline a safe treatment that allows control of alpha (1)AT-deficiency panniculitis.