THERAPEUTIC HOTLINE: LETTERS Lichenoid drug eruption induced by colchicine Asli Akin Belli*, Gonen Mengi†, Yelda Dere‡ & Gursoy Dogan* *Departments of Dermatology, Mugla Sitki Kocman University Training and Research Hospital, 48000 Mugla, Turkey, †Departments of Rheumatology, Mugla Sitki Kocman University Training and Research Hospital, 48000 Mugla, Turkey and ‡Departments of Pathology, Mugla Sitki Kocman University Training and Research Hospital, 48000 Mugla, Turkey Dear editor, Colchicine is an alkaloid that has been first used in the treatment of gout. It has been widely used in some cutaneous diseases such as Behc¸et’s dis- ease, recurrent aphthous stomatitis, and Sweet’s syndrome. Colchicine prevents the formation of microtubules and stops mitosis at metaphase. The cells with high mitotic activity such as cili- ated cells, cells of hair follicles, and leukocytes are more sensitive to colchicine effect. Conse- quently, it inhibits cell-mediated immune response (1). Whereas the majority of side effects of colchicine are gastrointestinal effects, cutane- ous adverse reactions have been reported rarely (1,2). Herein we report a case of lichenoid drug eruption (LDE) induced by colchicine. A 68-year-old female presented with extensive pruritic rash on the limbs for 10 days. Two weeks prior to this eruption, the patient started colchi- cine 0.5 mg orally three times per day to treat erythema nodosum. She had also hypertension, chronic obstructive pulmonary disease, and chronic renal failure and, therefore, she was tak- ing candesartan and hydrochlorothiazide com- bination, montelukast sodium, allopurinol, budesonide, and ipratropium bromide for 2 years. On examination, there were extensive, dis- crete, flat-topped, erythematous-violaceous pap- ules, diameters ranging 5–8 mm, on flexor and extensor sides of the limbs (Figure 1a–d). The mucous membranes and nails were normal. Lab- oratory investigations were normal. We obtained a punch biopsy from the skin lesions on the right leg. Since colchicine could be responsible for the eruption, we stopped the colchicine treat- ment. Two weeks later, we noted that the skin lesions had cleared without any treatment other than withdrawal of colchicine, leaving post- inflammatory hyperpigmentation in the previ- ously affected areas. The biopsy specimen showed focal parakeratosis, a band-like lichenoid infiltration consisting of lymphocytes and occa- sional eosinophils in the upper dermis, spongio- sis, focal interruption of the granular layer, and hydropic degeneration with a few necrotic kera- tinocytes in the basal layer (Figure 2a–e). Histo- pathological findings, clinical findings, and the linear relationship between the rash and colchi- cine treatment confirmed our diagnosis as LDE. The patient had been taking many medications for other chronic diseases long-term, so these Address correspondence and reprint requests to: Asli Akin Belli, MD, Department of Dermatology, Mugla Sitki Kocman University Training and Research Hospital, Orhaniye Mah., Ismet Catak Cad., 48000 Mugla, Turkey or e-mail: dr_asliakin@hotmail.com Conflict of interest: None. 7 Dermatologic Therapy, Vol. 29, 2016, 7–9 Printed in the United States Á All rights reserved V C 2015 Wiley Periodicals, Inc. DERMATOLOGIC THERAPY ISSN 1396-0296