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Year : 1995  |  Volume : 61  |  Issue : 1  |  Page : 56-57

Colchicine in the treatment of subcorneal pustular dermatosis

Correspondence Address:
K Pavithran

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Source of Support: None, Conflict of Interest: None

PMID: 20952880

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A male patient with subcorneal pustular dermatosis was initially treated with dapsone with excellent response. Since he developed hypersensitivity to dapsone, corticosteroid was given instead of dapsone. But steroid also was withdrawn since he developed hypertension and diabetes. There was relapse of skin lesions which were treated with oral colchicine, which has profound inhibitory effects on neutrophils. There was excellent therapeutic response to colchicine and the drug well-tolerated.

Keywords: Subcorneal pustular dermatosis, Colchicine

How to cite this article:
Pavithran K. Colchicine in the treatment of subcorneal pustular dermatosis. Indian J Dermatol Venereol Leprol 1995;61:56-7

How to cite this URL:
Pavithran K. Colchicine in the treatment of subcorneal pustular dermatosis. Indian J Dermatol Venereol Leprol [serial online] 1995 [cited 2019 May 23];61:56-7. Available from: http://www.ijdvl.com/text.asp?1995/61/1/56/4134

  Introduction Top

Subcorneal pustular dermatosis (SCPD) is characterized by chronic recurrent vesiculopustular eruption involving predominatly the intertriginous and flexural regions of the body. The exact cause of SCPD is not known. Neutrophil accumulation in the subcorneal location is the characteristic histologic feature. Most cases respond to dapsone. Here a patient with SCPD is reported who could not tolerate dapsone and corticosteroid. Oral colchicine given as a trial gave excellent therapeutic response.

  Case Report Top

A 40-year-old male patient developed recurrent, mildly pruritic, crops of discrete, superficial, tiny, oval, flaccid pustules for 6 years with a tendency to be arranged in annular and serpiginous patterns and were distributed bilaterally on the lower abdomen, axillae and groins. The pustules used to dry up in 6-7 days to form thin, dry crusts that fell leaving hyperpigmentation. There were no oral lesions. Nikolsky sign was negative. A skin biopsy revealed histological features of SCPD. Routine laboratory tests on blood and urine were normal. LFT, RFT and blood sugar levels were within normal limits. There was excellent therapeutic response to dapsone 100 mg bid, given for 10 days but the drug was stopped since he developed maculo-papular allergic rash to it. Oral tetracycline did not give any beneficial effect. Prednisolone was started in a dose of 60 mg daily and the lesions regressed within 14 days. Dose of steroid was tapered off and finally maintained on 10 mg daily. Meanwhile he developed hypertension and diabetes. On stopping steroid fresh crops of SCPD appeared. The patient was given oral colchicine 0.5 mg twice daily and the pustules subsided completely on the seventh day, after which dose of colchicine was reduced to 0.5 mg daily. There is no recurrence of skin lesions and the drug is well- tolerated.

  Discussion Top

Dapsone is the drug of choice for the treatment of SCPD. It has profound inhibitory effect on neutrophils[1], which explains its effect in SCPD. Neutrophils play important role in the pathogenesis of SCPD. Since our patient was allergic to dapsone we tried colchicine, another drug known to have inhibitory effect on polymorphonuclear leucocytes.[2] Therapeutic response was excellent. No undesirable effects of the drug were noticed during the course of treatment.

Colchicine's value in the treatment of acute gouty arthritis is well establised. It has also been reported effective in the treatment of diseases characterized by enhanced leucocyte chemotaxis and intense neutrophilic infiltration. These include Behcets disease, leucocytoclatic vasculitis, Sweet's syndrome and type 2 lepra reaction.[2][3][4][5] The long term safety of colchicine in treatment of Behcet's disease is well-established. Beneficial effect observed in our patient suggests that SCPD also should be included in the list of colchicine-responsive dermatoses.

  References Top

1.Wallace SI, Omokoku B, Ertel N H. Colchicine plasma levels. Am J Med 1970;48:443-4.  Back to cited text no. 1    
2.Matsumura N, Mizushima Y. Leucocyte movement and colchicine treatment in Behect's disease. Lancet 1975;2:813.  Back to cited text no. 2    
3.Callen J P. Colchicine is effective in controlling chronic cutaneous leucocytoclastic vasculitis. J Am Acad Dermatol 1985;13:193-200.  Back to cited text no. 3    
4.Suehisa S, Tagami H. Treatment of acute febrile neutophilic dermatosis (Sweets syndrome) with colchicine. Br J Dermatol 1981;105:483.  Back to cited text no. 4    
5.Kar HK, Roy RG. Comparison of colchicine and aspirin in the treatment of type 2 lepra reaction. Lep Rev 1988;59:201-3.  Back to cited text no. 5  [PUBMED]  

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