Correspondence

Colchicine Therapy for Palmar Fibromatosis

N Engl J Med 1995; 333:393August 10, 1995

Article

To the Editor:

I had multiple large and painful fibromatoses of the flexor tendon sheaths of the fourth and fifth digits bilaterally for at least 10 years and was unable to extend the right fifth digit to form a right angle with the palm for more than 4 years. I was contemplating remedial surgery when I found a report of a woman with this disorder who was treated with oral colchicine, with marked improvement clinically and on the basis of electron-microscopical findings.1 My search of the medical literature and medical–surgical consultations revealed no other claims of effective medical treatment, but did provide that surgery is often not effective. With little to lose, I took 1.2 mg of colchicine twice daily for seven days and then 0.6 mg daily for three weeks; for the past two years I have been taking 1.2 mg twice weekly.

The pain and tenderness decreased within hours after the first dose and virtually ceased within 72 hours. In about two weeks all 10 of the large lesions, which were 1 to 2 cm in diameter, had shrunk to less than half their former size, and I could actively extend the right fifth digit to 140 degrees (160 degrees passively) without pain. Attempts to reduce the dose or to extend the interval between doses have resulted in recurrence of pain and tenderness. There have been no noticeable side effects with this dosage, which is lower than the daily doses of 0.6 to 1.2 mg often taken for many years as prophylaxis against gout,2 or of 0.6 to 2.4 mg taken for the treatment of familial Mediterranean fever or as prophylaxis,3,4 or of 3 mg in the original report.1 No one should take colchicine without first learning its dose–response characteristics, its toxic effects, and the narrow range between therapeutic and toxic amounts.

Those interested in this condition should consider investigating this treatment systematically with various dosage schedules and histopathological studies.

Ferris N. Pitts, Jr., M.D.
University of Southern California School of Medicine, Pasadena, CA 91107

4 References

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   Livneh A, Zemer D, Siegal B, Laor A, Sohar E, Pras M. Colchicine prevents kidney transplant amyloidosis in familial Mediterranean fever. Nephron 1992;60:418-422
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   Tory P. Sullivan, Lloyd E. King, Alan S. Boyd. (1998) Colchicine in dermatology. Journal of the American Academy of Dermatology 39:6, 993-999
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