Transcript 1QS BID
Case conference 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 Question 2 Drug profile 96/12/01 Prednisolone 5mg/tab 皮膚科 96/12/04 2# TID Cetirizine 10mg/tab Amitriptyline 25mg/tab 2# TID 1# QID 1# HS 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 Mometasone cream 0.1% 5g/tube 96/12/20 1# HS Gabapentin 100mg/cap Hydrocortisone 10mg +Urea 100mg/g 10g/tube 96/12/11 1QS BID 1QS QD 3 Drug profile Loratadine 10mg/tab Dexchlorpheniramine 2mg/tab 免疫風濕科 因病患蕁麻疹之症狀改善 DC colchicine 98/03/31 但是，由於病患腳部仍有先前尚未痊癒的皮膚 98/04/07 98/04/14 98/04/28 98/05/12 98/05/26 1# QD 症狀因此持續給予口服antihistamine 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 Fluocinonide cream 0.05% 5g/tube 98/06/12 1QS BID 1QS BID Hydrocortisone 10mg +Urea 100mg/g 10g/tube 1QS BID Mometasone cream 0.1% 5g/tube 1QS BID 4 OUTLINE Classification Urticarial vasculitis Colchicine in the treatment of Urticarial vasculitis Conclusion 5 Cutaneous vasculitis. Classification Classification of cutaneous vasculitis can be initially based on Histopathology (vessel size, inflammatory infiltrate and immunoreactants.), clinical and laboratory features and etiology. 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, Am J Clin Dermatol 2008; 9 (2): 71-92 6 Urticarial vasculitis Introduction Epidemiology The initial report by McDuffie et al. in 1973 Urticarial vasculitis is a clinico-pathologic entity typified by recurrent episodes of urticaria Histopathologic features of leukocytoclastic vasculitis Classified as primary, secondary 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 7 Steps in the drug treatment of urticaria vasculitis An Bras Dermatol. 2005;80(6):613-32. 11 Am J Clin Dermatol 2008; 9 (2): 71-92 Am J Clin Dermatol 2008; 9 (2): 71-92 Urticarial vasculitis treated with colchicine Micromedex Non-FDA Labeled Indications ：Vasculitis General 1 study (Callen, 1985) reported the successful use of colchicine in 12 out of 13 patients with chronic cutaneous leukocytoclastic vasculitis. Micromedex 0.5 to 0.6 milligram 2 to 3 times daily treatment of refractory urticarial vasculitis, leukocytoclastic vasculitis, and mononuclear vasculitis 0.6 milligram orally twice daily Improvement was observed within 7 to 10 days following the initiation of therapy. 1 study colchicine was no more effective than topical emollients in the treatment of cutaneous leukocytoclastic vasculitis (Sais et al, 1995). 14 Conclusion Urticarial vasculitis is a subtype of leukocytoclastic 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 16 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 Dermatol 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 17 Thank you for your attention!