International Journal of Trichology International Journal of Trichology
 Print this page Email this page Small font sizeDefault font sizeIncrease font size
 
 
  Home | About IJT | Editorial board | Search | Ahead of print | Current Issue | Archives | Instructions | Online submission | Subscribe | Advertise | Contact us | Login   
 


 
 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 4  |  Page : 171-172  

Anagen effluvium following acute colchicine poisoning


1 Department of Dermatology, Hospital Clinic de Barcelona, Barcelona, Spain
2 Department of Psichyatry, Hospital Clinic de Barcelona, Barcelona, Spain

Date of Web Publication28-Mar-2017

Correspondence Address:
Andrea Combalia
Hospital Clinic, C/Villarroel 170, 08036, Barcelona
Spain
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-7753.203171

Rights and Permissions
   Abstract 

We present a case of a 17-year-old girl admitted to the Psychiatric Department recovering from a suicide attempt with colchicine. One week after poisoning, a sudden onset of hair loss was observed. Positive hair pull test and trichoscopy demonstrated the presence of anagen hairs with pigmented long roots covered by the root sheaths. Colchicine poisoning is an uncommon, but potentially life-threatening toxicologic emergency. An overdose of colchicine inhibits cell division, and thus the most affected organs are those which have a high rate of cell turnover. Hair loss resulting from colchicine poisoning presents as anagen effluvium, as it occurs with an exposure to toxic chemicals. Pharmacotherapy or specific treatment is not usually required, since the follicle resumes its normal activity after withdrawal of the antimitotic factors.

Keywords: Alopecia, anagen, colchicine, effluvium


How to cite this article:
Combalia A, Baliu-Piqué C, Fortea A, Ferrando J. Anagen effluvium following acute colchicine poisoning. Int J Trichol 2016;8:171-2

How to cite this URL:
Combalia A, Baliu-Piqué C, Fortea A, Ferrando J. Anagen effluvium following acute colchicine poisoning. Int J Trichol [serial online] 2016 [cited 2020 Jul 9];8:171-2. Available from: http://www.ijtrichology.com/text.asp?2016/8/4/171/203171


   Introduction Top


Colchicine is an alkaloid found in the plant Colchicurn autumnal, first recommended for the relief of articular pain in the 6th century A.D., and now most commonly used to treat gout, familial  Mediterranean fever More Details,[1] Behçet's disease,[1] atrial fibrillation following cardiac tissue ablation,[2] and pericarditis.[2],[3] Colchicine poisoning is an uncommon, but potentially life-threatening toxicologic emergency. An overdose of colchicine inhibits cell division, and thus the most affected organs are those that have a high rate of cell turnover, such as the gastrointestinal tract, bone marrow, and hair follicles. Colchicine poisoning typically shows three phases: Initially, gastrointestinal symptoms predominate; in the second phase, multiorgan failure may occur; and if the patient survives, the third phase of recovery follows, during which the patient often presents with hair loss.[4]


   Case Report Top


We present a case of a 17-year-old girl with a personal history of depression, several suicide attempts, alimentary behavioural disorder, and a recently diagnosed pericarditis, for which she was taking colchicine (1 mg/day). She was admitted to the Psychiatric Department of our hospital after recovering from a suicide attempt, apparently taking 40 pills of colchicine (40 mg), which led to severe pancreatitis and bicytopenia. One week after poisoning, a sudden onset of hair loss was observed [Figure 1]. Positive hair pull test (+++) and trichoscopy demonstrated the presence of anagen hairs with pigmented long roots covered by the root sheaths [Figure 2]a. Dermoscopy of the scalp showed no signs of trichotillomania such as broken hairs, black dots, flame hair, V-sign, or follicular hemorrhages [Figure 2]b. The diagnosis of anagen effluvium following acute colchicine poisoning was made.
Figure 1: Hair loss on day 7 after colchicine poisoning

Click here to view
Figure 2: (a) Trichoscopy of anagen hairs collected with hair pull test. (b) Dermoscopy of the scalp where no signs of trichotillomania such as broken hairs, black dots, flame hair, V-sign, or follicular hemorrhages can be observed

Click here to view



   Discussion Top


As occurs with exposure to toxic chemicals, hair loss due to colchicine poisoning presents as anagen effluvium.[5] Hair loss usually begins 7–14 days after the exposure and gradually recovers after 3–6 months, as the follicular ostia remains intact. Pharmacotherapy or specific treatment is not usually required because the follicle resumes its normal activity after withdrawal of the antimitotic factors. Anagen effluvium should be differentiated from telogen effluvium, androgenetic alopecia, and trichotillomania.[6] In this case, we focused on the differential diagnosis between trichotillomania and anagen effluvium because of the personal psychiatric history of the patient. There are few reports in the literature describing hair loss following acute colchicine poisoning,[7],[8],[9],[10] and none of them are recent.[10] To our knowledge, this is the first report describing the dermoscopic and trichoscopic findings in colchicine poisoning alopecia. Physicians should bear in mind this infrequent cause of anagen effluvium and try to avoid prescribing colchicine to psychiatric patients due to its potentially dangerous side effects.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Leung YY, Yao Hui LL, Kraus VB. Colchicine – Update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum 2015;45:341-50.  Back to cited text no. 1
    
2.
Verma S, Eikelboom JW, Nidorf SM, Al-Omran M, Gupta N, Teoh H, et al. Colchicine in cardiac disease: A systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord 2015;15:96.  Back to cited text no. 2
    
3.
Imazio M, Gaita F, LeWinter M. Evaluation and treatment of pericarditis: A systematic review. JAMA 2015;314:1498-506.  Back to cited text no. 3
    
4.
Ben-Chetrit E, Levy M. Colchicine: 1998 update. Semin Arthritis Rheum 1998;28:48-59.  Back to cited text no. 4
    
5.
Malkinson FD, Lynfield YL. Colchicine alopecia. J Invest Dermatol 1959;33:371-84.  Back to cited text no. 5
    
6.
Rakowska A, Slowinska M, Olszewska M, Rudnicka L. New trichoscopy findings in trichotillomania: Flame hairs, V-sign, hook hairs, hair powder, tulip hairs. Acta Derm Venereol 2014;94:303-6.  Back to cited text no. 6
    
7.
Biçer S, Soysal DD, Ctak A, Uçsel R, Karaböcüoglu M, Uzel N. Acute colchicine intoxication in a child: A case report. Pediatr Emerg Care 2007;23:314-7.  Back to cited text no. 7
    
8.
Güven AG, Bahat E, Akman S, Artan R, Erol M. Late diagnosis of severe colchicine intoxication. Pediatrics 2002;109:971-3.  Back to cited text no. 8
    
9.
Gooneratne BW. Massive generalized alopecia after poisoning by Gloriosa superba. Br Med J 1966;1:1023-4.  Back to cited text no. 9
    
10.
Duff IF, Mikkelsen WM, Salin RW. Alopecia totalis after desacetylmethylcolchicine therapy of acute gout; report of a case. N Engl J Med 1956;255:769-70.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed1957    
    Printed27    
    Emailed0    
    PDF Downloaded38    
    Comments [Add]    

Recommend this journal