Colchicine for dermatologic diseases

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

Ang and Tay (39) described a case of linear IgA bullous dermatosis in a 5-year-old girl who had tense bullae and vesicles over her face, arms, trunk, and legs with some surrounding crusts and vesicles forming a rosette pattern. She had been treated before with prednisolone (1 mg/kg/day) and dapsone (50 mg daily) and had a good response, but developed hemolytic anemia. The patient was then treated with colchicine alone (0.5 mg twice daily). Remission was complete in 2 weeks and she was still in remission 6 months after the beginning of the treatment with colchicine.

Zeharia et al (40) described a 3-year-old boy who had a pruritic blistering disease for 9 months. Histopathology and immunofluorescence confirmed linear IgA bullous disease. The child was G6PD-deficient, so he could not use dapsone. The treatment began with prednisone 2 mg daily. Complete remission was achieved in 2 weeks. He had a severe recurrence when the steroid was being tapered and also became cushingoid. An alternative treatment was mandatory for this patient, so colchicine was started at 0.5 mg twice daily while prednisone was gradually stopped. After 2 weeks, there was total remission without relapses while taking colchicine. The drug was stopped after 8 months and he had a mild relapse which resolved spontaneously.

Leukocytoclastic Vasculitis

Cutaneous leukocytoclastic vasculitis is an inflammatory vascular disease that may be limited to the skin or may develop as a manifestation of a systemic vasculitic disorder. The causal agent is unknown in most patients, but it is known that the deposition of immune complexes and complement in the vessel wall is important in the pathogeny of leukocytoclastic vasculitis. There is no well-established therapy for this entity, but most authors avoid the use of cytotoxic agents for vasculitis limited to the skin; that is why colchicine has been used.

Sais et al (41) randomly selected 41 patients receiving 0.5 mg of colchicine twice daily or topical emollients. After 1 month, treatment was withdrawn in those patients who had a complete response or no response. In patients with a partial response, treatment was maintained for the following 2 months. In patients who had a relapse, treatment was maintained for 3 months. Twenty patients in each group completed 1 month of treatment. One patient taking colchicine dropped out because of diarrhea. At the end of the first month, 5 patients in the control group and 4 patients in the colchicine group achieved a complete response. Nine patients that had a partial response (4 in the colchicine group and 5 in the control group) continued to receive treatment for the following 2 months. Three patients in the colchicine group suffered a relapse after discontinuing therapy. At the end of a 3-month period, 12 patients in the colchicine group and 10 patients in the control group showed no significant response. Complete response was achieved in 5 patients in the colchicine group and in 7 in the control group. After 1 year follow-up, 10 patients in each group had no evidence of cutaneous vasculitis.