J. Am. Acad. Dermatol.

BACKGROUNDEpidermolysis bullosa simplex (EBS) is a rare genetic, blistering skin disease for which there is no cure. Treatments that address the pathophysiology of EBS are needed.OBJECTIVECompare the impact of 1% diacerein cream with placebo in reducing the number of blisters in EBS.METHODSIn a randomized, placebo-controlled, phase 2/3 trial we used a 1% diacerein topical formulation to treat defined skin areas in 17 patients. In a 2-period crossover trial, patients were randomized to either placebo or diacerein for a 4-week treatment and a 3-month follow-up in period 1. After a washout, patients were crossed over during period 2. The prespecified primary end point was the proportion of patients with a reduction of number of blisters by more than 40% from baseline in selected areas over the treatment episode.RESULTSOf the patients receiving diacerein, 86% in episode 1 and 37.5% in episode 2 met the primary end point (vs 14% and 17% with placebo, respectively). This effect was still significant after the follow-up. Changes in absolute blister numbers were significant for the diacerein group only. No adverse effects were observed.LIMITATIONSLow patient numbers and no invasive data acquisition because of clinical burden in children.CONCLUSIONThis trial provides evidence of the impact of 1% diacerein cream in the treatment of EBS.KEYWORDSdiacerein, epidermolysis bullosa, keratin, rare genodermatosisCopyright © 2018 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.