Cutaneous manifestations of interferon alfa and ribavirin for hepatitis C

Abstract

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.