Re: "Erythema Annulare Centrifugum due to Pegylated Interferon-α-2a plus Ribavirin Combination Therapy in a Patient with Chronic Hepatitis C Virus Infection".

Abstract

To the Editor: We read with interest the article by Gonul and colleagues published in your journal reporting what they believed was possibly the first case of erythema annulare centrifugum (EAC) associated with pegylated interferon and ribavirin in the treatment of hepatitis C. The authors describe an annular erythematous eruption shortly after the introduction of interferon and ribavirin, followed by regression of lesions after interruption of hepatitis C therapy and subsequent recurrence within 24 hours of reinstitution of the same therapy. The histopathologic findings showed epidermal spongiosis, lymphocyte exocytosis, red cell extravasation, and a mild lymphocytic infiltrate in the upper dermis. The classic histopathologic feature of EAC, a dense perivascular ‘‘sleeve-like’’ lymphocytic infiltrate throughout the thickness of the dermis, was not seen in this case. However, the term EAC has grown to include similar clinical presentations, which have an entirely superficial and nonspecific histology of mild spongiosis and parakeratosis. We would like to highlight that we previously reported a similar case of an EAC-like eruption that had a comparable clinical presentation following the initiation of pegylated interferon and ribavirin for the treatment of hepatitis C. The histopathologic findings in our case also lacked the classic EAC sleeve-like infiltrate. Similarly, the eruption was managed with a topical steroid and an oral antihistamine, which avoided the need to discontinue treatment for hepatitis C. This report of a similar EAC-like eruption associated with the use of pegylated interferon and ribavirin helps corroborate our initial report, supports our suggested management of the adverse reaction, and adds to the literature on cutaneous eruptions that can emerge in the management of hepatitis C.