Cutaneous manifestations of interferon alfa and ribavirin for hepatitis C

Background Combination of interferon alfa and ribavirin for hepatitis C is associated withnumerous cutaneous side effects, but the accurate incidence of these complications is notknown in our population. Objectives A prospective observational study was designed to evaluate the frequency andclinical pattern of cutaneous side effects in a cohort of patients receiving combination ofinterferon alfa and ribavirin for hepatitis C. Patients and methods This study was carried out as a collaborative effort by the Departmentsof Dermatology, Medicine and Gastroenterology at the Shaikh Zayed Hospital, Lahore, overa 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 takinginformed consent, detailed history and cutaneous examination, before treatment and thenmonthly for 6 months, were performed and recorded on a pro forma. Results 85/87 patients (97%) experienced 1 or more cutaneous side effects. The mostfrequent was hair loss and occurred in 56 cases (64%). Lingual pigmentation was noted in 42cases (48%) and generalized pigmentation in 24 (27%). Hypertrichosis of eyelashes(trichomegaly) and eyebrows (synophyrs) was observed in 32 (36%) and 30 (34%) casesrespectively. Pruritus occurred in 20 cases (23%), aphthous stomatitis was observed in 18cases (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), shoedermatitis (1 case) and lichen planus (1 case) aggravated. Eruptive seborrhoeic keratosis wasreported in (1 case). Conclusion Cutaneous adverse events during combination therapy of hepatitis C withinterferon alfa and ribavirin were frequent but did not warrant treatment discontinuation.