Colchicine for dermatologic diseases

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

Acquired Epidermolysis Bullosa

Acquired epidermolysis bullosa is a chronic bullous disease characterized by the presence of subepidermal vesicles and autoimmune phenomena related to collagen type VII. (42) There is production of autoantibodies against anchorage fibrils below the dense lamina of the dermoepidermal junction. The disease is characterized by the presence of bulla and erosions in the extremities, mainly after trauma. Those lesions heal with the milia formation. The disease can also present a more generalized picture with a disseminated eruption of vesicles and bulla, resembling bullous pemphigoid. Histopathology demonstrates subepidermal vesicles with the presence of an inflammatory infiltration composed of numerous neutrophils, lymphocytes, and histiocytes. Direct immunofluorescence reveals deposits of linear IgG in the dermoepidermal junction. The Salt Split Test shows the presence of IgG in the dermal part of the dermoepidermal junction.

Two acquired epidermolysis bullosa patients were successfully treated by Megahed and Scharffetter-Kochanek. (43) They administered an initial oral dose of 2 mg/day. After 2 weeks of therapy, a dramatic improvement was observed. After 6 months, a maintenance dose of 1 mg/day colchicine was given. The disease had remained stable in both patients for more than 8 months at the time of the writing of this article.

Cunningham et al (42) also demonstrated the efficacy of systemic colchicine in 4 patients with acquired epidermolysis bullosa of difficult control. The first patient previously used prednisone without any response. Colchicine was then introduced in a dose of 0.5 mg/day. After 2 weeks of medication, the lesions had decreased intensely, but even with this response the dose was increased to 1 mg/day for a better result. After 2 months, prednisone was reduced to 5 mg/day and the dose of 1 mg/day of colchicine was maintained. The patient was free of clinical lesions for 1 year.

Engineer et al (44) described a successful treatment of EBA with colchicine in 6 patients. Three of them were male and 3 were female. The average age was 67 years old with an age range of 35 to 75 years old. These patients had severe and extensive disease that was refractory to usual steroid therapy. The duration of the disease ranged from 2 months to 6 years. Four patients received colchicine 1 to 2 mg daily as monotherapy. Two patients received steroids as well, and the last one received colchicine, azathioprine, and sulfapyridine. No side effects were seen in 5 patients. One of them had diarrhea when the dose ranged more than 1.2 mg daily. All 6 patients had a great response to colchicine. Healing of old lesions and decreasing of blistering formation occurred in all of them. The two patients that were receiving corticosteroid could taper and even discontinue its use without relapse. Follow-up periods ranged between 12 and 48 months after the administration of colchicine.

Condylomata Acuminata

Von Krogh described the successful treatment of condylomata acuminata with an 8% topical solution of colchicine. The results were similar to those with 20% podophyllin, but produced greater irritation. (26, 45)