Afro-Egypt J Infect  Endem  Dis  2016 June ; 6(2):94

Dermatological Manifestations of Pegylated Interferon alfa2a and Ribavirin Combination Therapy in Chronic HCV Patients

Mohamed H. Khater¹, Fathia M Khattab¹, Mohamed M. Refaey²

¹Department of Dermatology and Andrology, Faculty of Medicine, Zagazig University, Egypt                                         ² Tropical Medicine Department, Faculty of Medicine, Zagazig University, Egypt

rifae2007@yahoo.com

 

ABSTRACT

Background and study aim: Dermatological adverse events are an existing concern during treatment of chronic hepatitis C virus infection. Pegylated Interferon (peg –IFN- alfa2a) and ribavirin combination therapy is associated with well-characterized dermatological lesions tending towards a uniform entity of dermatitis. A prospective observational study was designed to evaluate the frequency and clinical pattern of cutaneous side effects in a cohort of patients receiving combination therapy of (pegylated interferon alfa2a) and ribavirin for chronic hepatitis C infection.

Patients and Methods: This study was carried out at Alahrar Center for treating chronic hepatitis C patients which is one of the centers of the national committee for treating chronic hepatitis C patients (HCV), Zagazig, Sharkia governorate, Egypt over a period of one year starting from January, 2014 to December 2014. A cohort of 116 consecutive, HCV-positive patients to be treated with pegylated interferon alfa2a and ribavirin with standard doses, were prospectively enrolled. After taking an informed consent, detailed history and cutaneous examination, before treatment and then monthly follow up for one year(during the course of treatment) were performed and recorded .All patients were subjected to throughout, routine laboratory investigations before enrollment including, CBC, random blood sugar, complete liver and renal function tests, TSH, Alfa fetoprotein, antibilharzial Ab titre, ANA, P.T, INR, quantitative PCR for HCV-RNA, pregnancy test was performed for the ladies.

Results: 113/116 patients (97%) experienced 1 or more cutaneous side effects. The most frequent was hair loss and occurred in 69 cases (Session [CurrentTestPartTermID]%). Pigmented Oral lichen planus was noted in 50 cases (43%) and generalized pigmentation in 32 (27%). Hypertrichosis of eyelashes (trichomegaly) and eyebrows (synophyrs) was observed in 42 (36%) and 40 (34%) cases respectively. Pruritus occurred in 50 cases (43%), aphthous stomatitis was observed in 33 cases (38%), 19 patients (22%) either developed or had worsening of melasma and 23 (27%) developed urticaria. Brittle nails (10 cases), cheilitis (8 cases), glossitis (3 cases), actinic  lichen planus (9 cases), greying of hair (3 cases), discoloration of moustache hair (1 case), and photo-sensitivity (3 cases)  were also observed. Preexisting psoriasis (8 cases), and lichen planus (5 cases) aggravated. Eruptive seborrhoeic keratosis was reported in 1 case.

Conclusion: 113/116 patients (97%) experienced 1 or more cutaneous side effects. The most frequent was hair loss and occurred in 69 cases (Session [CurrentTestPartTermID]%). Pigmented Oral lichen planus was noted in 50 cases (43%) and generalized pigmentation in 32 (27%). Hypertrichosis of eyelashes (trichomegaly) and eyebrows (synophyrs) was observed in 42 (36%) and 40 (34%) cases respectively. Pruritus occurred in 50 cases (43%), aphthous stomatitis was observed in 33 cases (38%), 19 patients (22%) either developed or had worsening of melasma and 23 (27%) developed urticaria. Brittle nails (10 cases), cheilitis (8 cases), glossitis (3 cases), actinic  lichen planus (9 cases), greying of hair (3 cases), discoloration of moustache hair (1 case), and photosensitivity (3 cases)  were also observed. Preexisting psoriasis (8 cases), and lichen planus (5 case) aggravated. Eruptive seborrhoeic keratosis was rep case).