Treatment of α1-Antitrypsin–Deficiency Panniculitis With Minocycline

A small proportion of patients with α1-antitrypsin (α1AT) deficiency experience recurrent ulcerating panniculitis. Studies suggest that α1AT-deficiency panniculitis reflects an uncontrolled inflammatory process 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 hematologic ones. Tetracyclines have anticollagenase and anti-inflammatory activity and have been used successfully to treat this type of panniculitis.

We report the case of a 42-year-old woman with recurrent α1AT-deficiency panniculitis who did not tolerate the side effects of dapsone or systemic 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 α1AT-deficiency panniculitis.