Treatment of Pyoderma gangrenosum with Low-Dose Colchicine

Abstract

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown origin. Systemic agents occasionally administered provide either incomplete long-term control of the disease or have been associated with serious adverse side effects after chronic administration. We present two patients with PG successfully treated with low-dose colchicine. Antimitotic, anti-inflammatory and immunomodulating properties of colchicine might account for its beneficial effects in PG patients. Colchicine is effective and well tolerated in low doses by most patients. In addition, it is inexpensive and safer for long-term treatment than corticosteroids and other immunosuppressive agents. Colchicine may be proposed either as a single agent or as a corticosteroid-sparing agent for early treatment of PG.

Infliximab for the Treatment of Disseminated Pyoderma Gangrenosum Associated with Ulcerative Colitis

“…If not successful, methylprednisolone 1 mg/kg in continuous infusion for 1–5 consecutive days [4, 6, 7] or cyclosporine in a dosage of 4–5 mg/kg/day has been associated with rapid responses [8,9,10,11,12]. Azathioprine [4, 58, 59], methotrexate [60], tacrolimus [61,62,63,64], thalidomide [65], dapsone [66, 67], mycophenolate mofetil [68], cyclophosphamide [69] and colchicine [70] have shown some effectiveness in case reports. Surgical procedures such as debridement should be avoided, since they may cause extension of the lesions and further tissue damage [71, 72].…”

Treatment of Idiopathic Pyoderma Gangrenosum with Infliximab: Induction Dosing Regimen or On-Demand Therapy?

“…Various proinflammatory cytokines including IL-8 and TNF-α may be expressed or overproduced in PG [13,14,15]. The TNF-α-inhibitory effects of thalidomide and colchicine might account for their beneficial effects in PG [4]. …”

“…Conventional therapeutics include prednisone, tacrolimus, dapsone, cyclosporine, clofazimine, thalidomide, colchicine, methotrexate, chlorambucil and intravenous human immunoglobulin [1,2,3]. Though it has been advised to avoid surgical procedures, due to the risk of the pathergy phenomenon, a report showed that refractory PG lesions could be treated by grafting with autologous epidermis equivalent [4]. …”

Pyoderma gangrenosum (1èrepartie) : mise au point

“…Les immunosuppresseurs, les immunomodulateurs ou les antimicrobiens ayant des propriétés anti-inflammatoires, comme la thalidomide [56,62,84], le mycophénolate mofétil [29], le tacrolimus [1][2][3]34], le méthotrexate [81], le cyclophosphamide [70], la dapsone [44], l'azathioprine [38], la clofazimine [54,55], la colchicine [47], les immunoglobulines intraveineuses [27], l'INFα [78], l'infliximab [38] et l'adalimumab [42,65,96], donnent des résultats satisfaisants lorsqu'ils sont utilisés comme traitements adjuvants ou en monothérapie pour les PG résistants aux corticostéroïdes. L'infliximab est acutellement considéré comme traitement de 1 ère intention chez les patients atteints simultanément d'un PG et d'une maladie intestinale inflammatoire chronique (recommandations de grade B) [69].…”