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).
Highlights
The incidence of hepatitis C virus (HCV) on a global scale as many as 2 to 3millions persons may be chronically infected in the United States, 5 to 10 millions in Europe, and about 12 millions in India, and most do not know they are infected
Most European countries report a prevalence of HCV in the general population of between 0.5 and 2%.WHO estimates that about 3% of the world’s population has been infected with HCV and that there are more than 170 million chronic carriers who are at risk of developing liver cirrhosis and/or liver cancer
Egypt has the highest prevalence of hepatitis C virus (HCV) in the world, estimated nationally at 14.7% [2]
Summary
The incidence of HCV on a global scale as many as 2 to 3millions persons may be chronically infected in the United States, 5 to 10 millions in Europe, and about 12 millions in India, and most do not know they are infected. Most European countries report a prevalence of HCV in the general population of between 0.5 and 2%.WHO estimates that about 3% of the world’s population has been infected with HCV and that there are more than 170 million chronic carriers who are at risk of developing liver cirrhosis and/or liver cancer. 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
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