Colchicine for dermatologic diseases

Journal of Drugs in Dermatology, March-April, 2005 by Roberta Bibas, Neide Kalil Gaspar, Marcia Ramos-e-Silva

Generalized Pustular Psoriasis (Von Zumbusch)

This form of psoriasis is an acute widespread eruption, with presence of pustules associated to high fever and leukocytosis, that may compromise the general health of the patient and evolve to death. (22)

Zachariae et al (23) described the benefits of colchicine using it in 4 patients, 3 of which obtained complete remission in 2 weeks. The dose was 0.5 mg, varying from 2 to 3 times a day. Three patients had no more fever and 2 had no more pustules after 1 week; while another one presented no pustules after 2 weeks. The erythroderma and the constitutional symptoms disappeared with the pustules. The main objective of the use of colchicine would be to avoid the prescription of more potentially hazardous drugs, such as methotrexate and systemic steroids, generally used for this disease. (19)

Pustulosis Palmaris et Plantaris

Palmoplantar pustulosis is a chronic disease characterized by the presence of sterile pustules on the thenar and hypothenar eminences, soles, and lateral aspect of the heel.

Mori et al administered 1 to 2 mg per day of colchicine to 32 patients with pustulosis palmaris et plantaris. Partial or complete remission occurred after 2 to 8 weeks of treatment. (24)

In a double-blind study, Thestrup-Pedersen and Reymann treated 27 palmoplantar pustulosis patients with 0.5 mg of colchicine 3 times a day for 4 weeks. In 10 of the patients (almost 40%), the pustules disappeared, but the scaling, erythema, and subjective symptoms continued. (9, 25, 26)

Takigawa et al treated 32 patients with 1 to 2 mg/day of colchicine in the exacerbation periods of the disease. The dose was lowered to 0.5 mg/day in the 28 who tolerated the drug. Thirteen of them evolved with a complete cure; 14 had a marked improvement after 2 to 8 weeks of treatment. After the drug was discontinued, 8 patients had a recurrence. The authors suggested colchicine should be used to treat acute cases of pustulosis palmaris et plantaris. (26, 27)

Wong et al treated 3 patients with palmoplantar pustulosis with oral colchicine with great results. The first patient started with 0.5 mg twice daily and then increased to 1 mg twice daily for 12 months. A significant reduction in the number of pustules was noted and there were no side effects. The second patient was a 49-year-old woman who had a 6-year history of sterile pustulosis palmaris et plantaris and nail dystrophy. The patient started with 0.5 mg twice daily and then increased to 1 mg twice daily. A marked reduction was noted in the frequency and duration of pustular eruptions and the numbers of pustules in each attack. The third patient had an improvement in his palmoplantar disease with 0.5 mg colchicine twice daily, but he could not tolerate higher doses because of diarrhea. (28)

Relapsing Polychondritis

Relapsing polychondritis is a disease characterized by inflammation outbreaks in the cartilaginous tissues. For the diagnosis, it is necessary to present 3 of the following symptoms: bilateral auricular chondritis, ocular inflammation, respiratory chondritis, or audio-vestibular impairment. (29)