Colchicine 使用於Urticarial Vasculitis治療評估

義大醫院藥劑科主講人：簡麗卿指導藥師：張美琪

98/07/29

Case conference

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Question

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Drug profile 皮膚科

96/12/01 96/12/04 96/12/11 96/12/20

Prednisolone 5mg/tab 2# TID 2# TID 1# QID

Cetirizine 10mg/tab 1# HS

Amitriptyline 25mg/tab 1# HS

Gabapentin 100mg/cap 1# BID

Homochlorcyclizine 10mg/tab 1# TID

Hydroxyzine 25mg/cap 1# TID

Doxepin cream 5% 15g/tube 1QS TID

Fluocinonide cream 0.05% 5g/tube 1QS QID

Hydrocortisone 10mg +Urea 100mg/g 10g/tube

1QS BID

Mometasone cream 0.1% 5g/tube 1QS QD

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Drug profile 免疫風濕科

98/03/31

98/04/07

98/04/14

98/04/28

98/05/12

98/05/26

98/06/12

Loratadine 10mg/tab 1# QD

Dexchlorpheniramine 2mg/tab 1# QD ~ TID

Cetirizine 10mg/tab 1# QD

Colchicine 0.5mg/tab 1# QD

Fexofenadine 180mg/tab 1# QD

Cyproheptadine 4mg/tab

1# HS

C.B. ointment 5g/tube 1QS BID

Fluocinonide cream 0.05% 5g/tube 1QS BID

Hydrocortisone 10mg +Urea 100mg/g 10g/tube

1QS BID

Mometasone cream 0.1% 5g/tube 1QS BID

因病患蕁麻疹之症狀改善 DC colchicine 但是，由於病患腳部仍有先前尚未痊癒的皮膚症狀因此持續給予口服 antihistamine

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OUTLINE

Classification Urticarial vasculitis Colchicine in the treatment of Urticarial vasculit

is Conclusion

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Cutaneous vasculitis. Classification

HSP: Henoch-Sch¨onlein purpura, CLA: cutaneous leukocytoclastic angiitis, PAN: polyarteritis nodosa, Nod Vas: nodular vasculitis, GCA: giant cell arteritis, CV: cryoglobulinemic vasculitis, CTD: connective tissue disease, ANCA+: antineutrophil cytoplasmic antibody positive vasculitis,

Classification of cutaneous vasculitis can be initially based on Histopathology (vessel size, inflammatory infiltrate and immunoreactants.), clinical and laboratory features and etiology.

Am J Clin Dermatol 2008; 9 (2): 71-92

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Urticarial vasculitis Introduction

The initial report by McDuffie et al. in 1973 Urticarial vasculitis is a clinico-pathologic entity typified by re

current episodes of urticaria Histopathologic features of leukocytoclastic vasculitis Classified as primary, secondary

Epidemiology A relatively rare condition Most commonly seen in individuals between 30 and 50 years

of age with a 3:1 female to male predominance. Feature Laboratory findings

Clinical Reviews in Allergy and Immunology. 2002;23:201-216

Southern Medical Journal. 2009;102:531-533

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Steps in the drug treatment of urticaria vasculitis

An Bras Dermatol. 2005;80(6):613-32.

Am J Clin Dermatol 2008; 9 (2): 71-92

Am J Clin Dermatol 2008; 9 (2): 71-92

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Urticarial vasculitis treated with colchicine

Micromedex Non-FDA Labeled Indications ： Vasculitis

General 0.5 to 0.6 milligram 2 to 3 times daily treatment of refractory urticarial vasculitis, leukocytoclastic v

asculitis, and mononuclear vasculitis 1 study (Callen, 1985) reported the successful use of colchic

ine in 12 out of 13 patients with chronic cutaneous leukocytoclastic vasculitis.

0.6 milligram orally twice daily Improvement was observed within 7 to 10 days following the i

nitiation of therapy. 1 study colchicine was no more effective than topical emoll

ients in the treatment of cutaneous leukocytoclastic vasculitis (Sais et al, 1995).

Micromedex

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Conclusion

Urticarial vasculitis is a subtype of leuko-cytoclastic vasculitis.

Colchicine have inhibit neutrophil chemotaxis, but with no controlled studies with small samples and completely proven efficacy.

At present is unknown that urticarial vasculitis treated with colchicine.

Arch dermatol 1995;131:1399-1402

Clinical Reviews in Allergy and Immunology. 2002;23:201-216

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Reference Joe Venzor, Wai L. Lee, David P. Huston. Urticarial Vasculitis. Clinical Reviews in Allergy

and Immunology. 2002;23:201-216 . Grattan C, Powell S, Humphreys F. Management and diagnostic guidelines for urticaria

and angio-edema. Br J Dermatol. 2001;144:708-14. Ko-Ron Chen, J. Andrew Carlson. Clinical Approach to Cutaneous Vasculitis. Am J Clin D

ermatol 2008;9(2):71-92. Criado PR, Criado RFJ, Maruta CW, et. al. Urticaria. An Bras Dermatol. 2005;80(6):613-32. Landon E. Stigall, Justin R. Sigmon, and Stuart S. Leicht. Urticarial Vasculitis: A Unique

Presentation. Southern Medical Journal. 2009;102(5):531-533. 林靖麒 , 楊麗珍 , 林宜婷 et al. 皮膚血管炎 -- 不同致病因之臨床分析 . J Rheumatol R.O.C.

2007;21:32-43. Micromedex

Thank you for your attention!