Cutaneous manifestations of interferon alfa and ribavirin for hepatitis C
DOI:
https://doi.org/10.66344/jpad.v18i1.560Keywords:
Hepatitis C, interferon alfa, ribavirin, cutaneous manifestations, trichomegaly, tongue pigmentationAbstract
Background Combination of interferon alfa and ribavirin for hepatitis C is associated with numerous cutaneous side effects, but the accurate incidence of these complications is not known in our population.
Objectives A prospective observational study was designed to evaluate the frequency and clinical pattern of cutaneous side effects in a cohort of patients receiving combination of interferon alfa and ribavirin for hepatitis C.
Patients and methods This study was carried out as a collaborative effort by the Departments of Dermatology, Medicine and Gastroenterology at the Shaikh Zayed Hospital, Lahore, over a period of 10 months starting from January, 2007. A cohort of 87 consecutive, HCV-positive, patients to be treated with interferon alfa (3 MIU subcutaneously thrice weekly) with 1200 mg of ribavirin daily for 24 weeks, were prospectively enrolled. After taking informed consent, detailed history and cutaneous examination, before treatment and then monthly for 6 months, were performed and recorded on a pro forma.
Results 85/87 patients (97%) experienced 1 or more cutaneous side effects. The most frequent was hair loss and occurred in 56 cases (64%). Lingual pigmentation was noted in 42 cases (48%) and generalized pigmentation in 24 (27%). Hypertrichosis of eyelashes (trichomegaly) and eyebrows (synophyrs) was observed in 32 (36%) and 30 (34%) cases respectively. Pruritus occurred in 20 cases (23%), aphthous stomatitis was observed in 18 cases (21%), 16 patients (18%) either developed or had worsening of melasma and 14 (16%) developed urticaria. Brittle nails (8 cases), cheilitis (6 cases), glossitis (4 cases), lichen planus (5 cases), greying of hair (5 cases), discoloration of moustache hair (1 case), photosensitivity (3 cases) and alopecia areata (1 case) were also observed. Preexisting psoriasis (2 cases), shoe dermatitis (1 case) and lichen planus (1 case) aggravated. Eruptive seborrhoeic keratosis was reported in (1 case).
Conclusion Cutaneous adverse events during combination therapy of hepatitis C with interferon alfa and ribavirin were frequent but did not warrant treatment discontinuation.
References
1. Anis LA, Gaspari AA. Cutaneous reactions to recombinant cytokine therapy. J Am Acad Dermatol 1995; 33: 393-410.
2. Koshy A, Marcellin P, Martinot M, Madda JP. Improved response to ribavirin interferon combination compared with interferon alone in patients with type 4 chronic hepatitis C without cirrhosis. Liver 2000; 20: 335-9.
3. Lau J. Mechanism of action of ribavirin in the combination treatment of chronic HCV. J Hepatology 2002; 35: **.
4. Besiss D, Luong MS, Blanc P et al. Straight hair associated with interferon plus ribavirin in hepatitis C infection. Br J Dermatol 2002; 147: 392-3.
5. Hernandez-Nunez A, Fernandez-Herrera J, Buceta LR, Garcia-Diez A. Trichomegaly with interferon alpha-2b. Lancet 2002; 30:359(9312):1107.
6. Howaizi M. Pegylated interferon-induced eyelid and eyebrow trichomegaly during chronic hepatitis C. J Gastroenterol Hepatol 2005; 20:1945-6.
7. Baccard M, Morel P. Excessive growth of eyelashes in patients with acquired immunodeficiency syndrome. Cutis 1994; 53: 83-4.
8. Javamanne DG, Davan MR, Porter R. Cyclosporin-induced trichomegaly of accessory lashes as a cause of ocular irritation. Nephrol Dial Transplant 1996; 11: 1159-61.
9. Bouche O, Brixi-Benmansour H, Bertin A et al. Trichomegaly of the eyelashes following treatment with cetuximab. Ann Oncol 2005; 16: 1711-2.
10. Ward KM, Barnett C, Fox LP, Grossman ME. Eyelash trichomegaly associated with systemic tacrolimus. Arch Dermatol 2006; 142: 248.
11. Taliana G, Biliolli E, Cappanni M et al. Reversible alopecia universalis during treatment with PEG-interferon and ribavirin for chronic hepatitis C. J Chemother 2005; 17: 212-4.
12. Torres HA, Bull L, Arduino RC, Barnett BJ. Tongue hyperpigmentation in a Caucasian patient coinfected with HIV and Hepatitis C during peginterferon alfa-2b and ribavirin therapy. Am J Gastroenterol 2007; 102:
1334-5.
13. Willems M, Munte K, Den Hollander JC et al. Hyperpigmentation during interferon-alpha therapy for chronic hepatitis C virus infection. Br J Dermatol 2003; 149: 390-4.
14. Gurta C, Kauer C, Bergholz U et al. Tongue and skin hyperpigmentation during PEG-interferon-α/ribavirin therapy in dark-skinned non-caucasian patients with chronic hepatitis C. Am J Gastroenterol 2005; 100: 1–2.
15. Willems M, Munte K, Vrolijk JM et al. Hyperpigmentation during interferon-alpha therapy for chronic hepatitis C virus infection. Br J Dermatol 2003; 149: 390-4.
16. Sood A, Midha V, Bansal M et al. Lingual hyperpigmentation with pegylated interferon and ribavirin therapy in patients with chronic hepatitis C. Indian J Gastroenterol 2006; 25: 324.
17. Barreca T, Corsini G, Franceschini R et al. Lichen planus-induced by interferon-alpha-2a therapy for chronic active hepatitis C. Eur J Gastroenterol Hepatol 1995; 7: 367-8.
18. Protzer U, Ochsendorf FR, Leopolder-Ochsendorf A, Holtermuller KH. Exacerbation of lichen planus during interferon alfa-2a therapy for chronic active hepatitis C. Gastroenterology 1993; 104: 903-5.
19. Jauregui L, Garcia-patos V, Pedragosa R et al. Lichen planus associated with liver disease caused by hepatitis C virus. Gastroenterol Hepatol 1996; 19:507-10.
20. Sanchez-Perez J, De Castro M, Buezo GF et al. Lichen planus and hepatitis C virus: prevalence and clinical presentation of patients with lichen planus and hepatitis C virus infection. Br J Dermatol 1996; 134: 715-9.
21. Bellman B, Reddy R, Falanga V. Generalized lichen planus associated with hepatitis C virus immunoreactivity. J Am Acad Dermatol 1996; 35: 770-2.
22. Schlesinger TE, Camisa C, Gay D, Bergfeld WF. Oral erosive lichen planus with epidermolytic hyperkeratosis during interferon alfa-2b therapy for chronic hepatitis C virus infection. J Am Acad Dermatol 1997;
36: 1023-5.
23. Lodi G, Giuliana M, Majorana A et al. Lichen planus and hepatitis C virus: a multicentre study of patients with oral lesions and a systematic review. Br J Dermatol 2004; 151: 1172-81.
24. Harden D, Skelton H, Smith KJ. Lichen planus associated with hepatitis C: no viral transcripts are found in the lichen planus, and effective therapy does not clear lichen planus. J Am Acad Dermatol 2003; 49: 847-52.
25. Sparsa A, Loustaud-Ratti V, Liozon E et al. Cutaneous reactions or necrosis from interferon alpha: can interferon be reintroduced after healing? Six case reports. Rev Med Interne 2000; 21: 756-63.
26. Sanders S, Busam K, Tahan SA et al. Granulomatous and suppurative dermatitis at interferon alfa injection sites: reports of 2 cases. J Am Acad Dermatol 2002; 46: 611-6.
27. Cogrel O, Doutre MS, Marliere V et al. Cutaneous sarcoidosis during interferon plus ribavirin treatment of hepatitis C virus: two cases. Br J Dermatol 2002; 146: 320-4.
28. Fischer J, Metzler G, Schaller M. Cosmetic permanent fillers for soft tissue augmentation. A new contraindication for interferon therapy. Arch Dermatol 2007; 143: 507-10.
29. Raison CL, Borisov AS, Broadwell SD et al. Depression during pegylated interferon-alpha plus ribavirin therapy: prevalence and prediction. J Clin Psychiatry 2005; 66: 41-8.
30. Vignau J, Karlia L, Costisella O, Cannva V. Hepatitis C, and interferon a and depression: main physiopathlologic hypothesis. Encephale 2005; 31: 349-57.
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Copyright (c) 2016 Safoora Aamir, Zia Ullah, Zafar Iqbal, Anwar A Khan, Faryal Yaqub, Kashif Malik
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