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Glombicki SE, Cohen PR. Sofosbuvir-Velpatasvir (Epclusa)-Associated Photosensitivity in a Hepatitis C Patient: Case Report and Review of Photosensitivity to Hepatitis C Antiviral Agents. Cureus 2021; 13:e16496. [PMID: 34430111 PMCID: PMC8373598 DOI: 10.7759/cureus.16496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C is a ribonucleic acid (RNA) virus, and its presence in individuals was previously considered to be a chronic condition. However, recent therapeutic advances with virus-directed treatment have resulted in a significant increase in cure rates as demonstrated by an absence of virus on repeat testing. Currently, several individual and combination antiviral therapies are available for the treatment of hepatitis C virus infection. However, each of the hepatitis C antiviral agents is associated with potential adverse skin effects whose incidence varies depending on the agent used for treatment. The cutaneous reactions, including photosensitivity, usually resolve once the antiviral treatment is completed. In this report, we discuss the case of a chronic hepatitis C patient who developed sofosbuvir-velpatasvir (Epclusa)-associated toxicity, while receiving the antiviral therapy. The 57-year-old man developed cutaneous phototoxicity when he started treatment with the drug. The adverse skin reaction promptly resolved once the treatment was completed. Clinicians who manage patients being treated with antiviral agents for hepatitis C infection should consider counseling these individuals regarding photoprotection including avoidance of sun exposure, daily sunscreen use, and wearing photoprotective clothing.
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Affiliation(s)
- Stephen E Glombicki
- McGovern Medical School, University of Texas Health Science Center, Houston, USA
| | - Philip R Cohen
- Dermatology, San Diego Family Dermatology, National City, USA
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Abstract
Eczematous drug eruptions are a heterogenous group of skin reactions that resemble eczema both clinically and histologically. We reviewed the literature and cataloged the systemically administered medications that cause these eruptions, along with their characteristic clinical presentations. We identified three primary pathophysiologic etiologies: (1) cutaneous immunomodulation, (2) skin dehydration, and (3) delayed hypersensitivity. Notably, eczematous eruptions caused by altered immunity in the skin may be increasing in incidence as some responsible drugs, in particular biologic therapies (such as tumor necrosis factor-α and interleukin-17 inhibitors) and targeted cancer treatments (including immune checkpoint inhibitors and epidermal growth factor receptor inhibitors), become more commonly employed in clinical practice. Other notable causes of eczematous eruptions include antiviral agents for hepatitis C virus and cardiovascular medications in elderly individuals, and notable subtypes of eczematous reactions include systemic contact dermatitis and photoallergic reactions, which are also discussed. The diagnostic gold standard is drug rechallenge and most reactions may be treated effectively with emollients, topical corticosteroids, and oral antihistamines.
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Affiliation(s)
| | - Susan Burgin
- Harvard Medical School, Boston, MA, USA.
- Department of Dermatology, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
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Poreaux C, Bronowicki JP, Debouverie M, Schmutz JL, Waton J, Barbaud A. Clinical allergy. Managing generalized interferon-induced eruptions and the effectiveness of desensitization. Clin Exp Allergy 2014; 44:756-64. [PMID: 24128045 DOI: 10.1111/cea.12217] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND We evaluated the value of skin tests and the efficacy of a 12-step desensitization protocol to pegylated interferon (IFN) in patients with generalized drug eruptions due to IFNs. METHODS A retrospective study (1998-2009) was followed by a cross-sectional clinical study conducted prospectively (2009-2011). All patients received a dermatological clinical examination and skin tests. Twelve-step IFN desensitization was proposed for patient with active hepatitis C and no alternative therapy. RESULTS Twenty-six patients (13 males, mean age, 53.5 years) had generalized reactions to IFNs; 21 were treated with IFN-α and 5 with IFN-β. Moreover, 21 patients had skin tests. Intradermal tests (IDTs) were positive after an average of 72 h. Cross-reactivity between peg-IFN-α2a and peg-IFN-α2b was observed in 5/10 cases in the prospective study. In 16 of 26 cases, IFN treatment was stopped. In 8 of 16 cases of diffuse eczematous drug eruption, treatment was continued. The corticosteroid and antihistamine were sufficient in 4/8 cases. In three other cases, topical tacrolimus was highly effective. In 3 of 16 cases in which treatment were stopped, patients underwent the early resumption of peg-IFN-α. These three patients had positive tests with peg-IFN-α2a and peg-IFN-α2b and successfully completed the tolerance induction protocol for peg-IFN-α2b. Tolerance induction involved a weekly dose of peg-IFN and a gradual increase in the recovery of an antiviral C. Clinical tolerance was excellent, and the patients' viral load C became negative. CONCLUSIONS Our study demonstrates the benefit of allergy testing in cases of generalized drug reactions to IFN, cross-reactivities in a single class of IFNs and the importance of delayed IDT reading. We report for the first time the effectiveness of 12-step desensitization with peg-IFN.
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Affiliation(s)
- C Poreaux
- Dermatology Department, University Hospital of Nancy, Brabois Hospital, Vandoeuvre les Nancy, France
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Blood levels of S-100 calcium-binding protein B, high-sensitivity C-reactive protein, and interleukin-6 for changes in depressive symptom severity after coronary artery bypass grafting: prospective cohort nested within a randomized, controlled trial. PLoS One 2014; 9:e111110. [PMID: 25329583 PMCID: PMC4203837 DOI: 10.1371/journal.pone.0111110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/28/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cross-sectional and retrospective studies have associated major depressive disorder with glial activation and injury as well as blood-brain barrier disruption, but these associations have not been assessed prospectively. Here, we aimed to determine the relationship between changes in depressive symptom severity and in blood levels of S-100 calcium-binding protein B (S-100B), high-sensitivity C-reactive protein, and interleukin-6 following an inflammatory challenge. METHODS Fifty unselected participants were recruited from a randomized, controlled trial comparing coronary artery bypass grafting procedures performed with versus without cardiopulmonary bypass for the risk of neurocognitive decline. Depressive symptom severity was measured at baseline, discharge, and six-month follow-up using the Beck Depression Inventory II (BDI-II). The primary outcome of the present biomarker study was acute change in depressive symptom severity, defined as the intra-subject difference between baseline and discharge BDI-II scores. Blood biomarker levels were determined at baseline and 2 days postoperative. RESULTS Changes in S-100B levels correlated positively with acute changes in depressive symptom severity (Spearman ρ, 0.62; P = 0.0004) and accounted for about one-fourth of their observed variance (R2, 0.23; P = 0.0105). This association remained statistically significant after adjusting for baseline S-100B levels, age, weight, body-mass index, or β-blocker use, but not baseline BDI-II scores (P = 0.064). There was no statistically significant association between the primary outcome and baseline S-100B levels, baseline high-sensitivity C-reactive protein or interleukin-6 levels, or changes in high-sensitivity C-reactive protein or interleukin-6 levels. Among most participants, levels of all three biomarkers were normal at baseline and markedly elevated at 2 days postoperative. CONCLUSIONS Acute changes in depressive symptom severity were specifically associated with incremental changes in S-100B blood levels, largely independent of covariates associated with either. These findings support the hypothesis that glial activation and injury and blood-brain barrier disruption can be mechanistically linked to acute exacerbation of depressive symptoms in some individuals.
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Tuna N, Erdem MT, Karabay O. Onychomycosis Case Developing during Interferon Treatment. Balkan Med J 2014; 30:131-2. [PMID: 25207086 DOI: 10.5152/balkanmedj.2012.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nazan Tuna
- Department of Infectious Diseases and Clinical Microbiology, Sakarya Education and Research Hospital, Sakarya University, Sakarya, Turkey
| | - Mustafa Teoman Erdem
- Department of Dermatology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya Education and Research Hospital, Sakarya University, Sakarya, Turkey
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Esmat S, Elgendy D, Ali M, Esmat S, El-Nabarawy EA, Mahmoud SB, Shaker O. Prevalence of photosensitivity in chronic hepatitis C virus patients and its relation to serum and urinary porphyrins. Liver Int 2014; 34:1033-9. [PMID: 24575939 DOI: 10.1111/liv.12513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/21/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS HCV is a major cause of chronic liver disease in Egypt. The aim was to study the prevalence of photosensitivity among asymptomatic HCV-infected patients and its possible relation to porphyrins levels and whether it can be considered an alarm for early diagnosis of the disease, which is the most important goal in the management. METHODS This study included 100 accidentally discovered HCV positive cases and 100 HCV negative healthy controls. All patients and controls were subjected to: Detailed history and clinical examination, dermatological examination including evaluation of reaction to solar exposure, measurement of serum AST, ALT, albumin, bilirubin, serum and urinary porphyrins levels. RESULTS The prevalence of photosensitivity among HCV-positive cases (33%) was significantly higher compared to 10% in the control group. Serum porphyrins were positive in 46 cases (46%), twenty-three cases (23%) had positive urinary porphyrins, while only four controls (4%) showed positive serum porphyrins and one (1%) showed positive urinary porphyrins, the difference was statistically significant. Cases with photosensitivity showed significantly higher prevalence of serum and urinary porphyrins existence as well as serum porphyrins levels. Levels of viraemia showed statistically significant relation to levels of porphyrins. CONCLUSION Asymptomatic chronic HCV infection cases showed significantly high prevalence of photosensitivity, which is related to the associated disturbance of porphyrins metabolism. Photosensitivity can thus be considered an early marker of HCV infection. Patients discovered to have recently acquired photosensitivity should be screened for HCV infection especially in endemic areas like Egypt.
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Affiliation(s)
- Serag Esmat
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Predictive factors for adverse dermatological events during pegylated/interferon alpha and ribavirin treatment for hepatitis C. J Clin Virol 2014; 60:190-5. [PMID: 24830933 DOI: 10.1016/j.jcv.2014.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Treatment of chronic hepatitis C (CHC) with pegylated interferon-alpha/ribavirin is associated with well-characterized dermatological adverse events (AEs), which can lead to premature discontinuation of treatment. OBJECTIVE To investigate the incidence and spectrum of dermatological AEs during CHC treatment with interferon-alpha plus ribavirin and analyzed factors predisposing patients to such reactions. STUDY DESIGN Between January 2008 and December 2012, 152 CHC patients who had received interferon/pegylated interferon plus ribavirin therapy were enrolled in this retrospective study. To determine which factors were associated with dermatological AE development, a Cox proportional-hazards regression analysis was performed. RESULTS Thirty dermatological AEs were recorded in 28 (18.4%) patients. These reactions included 14 (9.2%) patients with eczematous reactions, four (2.6%) patients with xerosis, three (2.0%) patients with new-onset or exacerbation of psoriasis, two (1.3%) patients with lichenoid eruption, two (1.3%) patients with diffuse folliculitis and one patient with lichen planus, alopecia areata, hypermelanosis, and necrosis of the skin and toenails. Application of the Cox proportional-hazards model revealed that age older than 60 years (HR=1.070; 95% CI: 1.043-1.096), pre-existing anaphylaxis/skin disease (HR=2.612; 95% CI: 1.593-3.324), cirrhosis (HR=1.863; 95% CI: 1.047-3.013), and treatment with pegylated interferon formulations (HR=1.930; 95% CI: 1.052-3.687) were associated with occurrence of dermatologic AEs. Twenty-seven (90%) skin conditions were classified as mild to moderate, while one case (3.3%) warranted premature discontinuation of treatment. CONCLUSION Dermatological AEs resulting from interferon-alpha/ribavirin treatment of CHC contribute to a wide spectrum involve the skin, mucous membrane, hair, and nails. These dermatological AEs correlated with older age, previous skin condition, cirrhosis, and use of pegylated interferon formulations.
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Federico A, Sgambato D, Cotticelli G, Gravina AG, Dallio M, Beneduce F, Ruocco E, Romano M, Loguercio C. Skin Adverse Events During Dual and Triple Therapy for HCV-Related Cirrhosis. HEPATITIS MONTHLY 2014; 14:e16632. [PMID: 24734094 PMCID: PMC3984470 DOI: 10.5812/hepatmon.16632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 12/19/2013] [Accepted: 12/30/2013] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Dermatological adverse events are an existing concern during treatment of hepatitis C virus infection. Peginterferon/ribavirin treatment is associated with well-characterized dermatological lesions tending towards a uniform entity of dermatitis. New telaprevir- or boceprevir-based triple-therapy has led to significant improvements in sustained virological response rates, although associated with an increase in cutaneous adverse events compared peginterferon/ribavirin alone. CASE PRESENTATION We report a case of a patient who discontinued telaprevir because of severe skin eruptions and who, during ribavirin and interferon treatment, after a period free of skin lesions, developed new dermatological lesions different than those experienced during telaprevir treatment. CONCLUSIONS Several adverse effects are associated to anti-HCV drugs, hence appropriate skin care management and follow-up are very important. A careful anamnesis before the initiation of triple therapy is necessary to identify previous dermatological diseases that could increase skin adverse effects incidence.
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Affiliation(s)
- Alessandro Federico
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
- Corresponding Author: Alessandro Federico, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy. Tel: +39-815666723, Fax: +39-815666714, E-mail:
| | - Dolores Sgambato
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Gaetano Cotticelli
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Antonietta Gerarda Gravina
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Marcello Dallio
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Filippo Beneduce
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Marco Romano
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
| | - Carmela Loguercio
- Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, Naples, Italy
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Slim J, Afridi MS. Managing adverse effects of interferon-alfa and ribavirin in combination therapy for HCV. Infect Dis Clin North Am 2013; 26:917-29. [PMID: 23083824 DOI: 10.1016/j.idc.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This article focuses on the adverse effects of hepatitis C therapy, which includes pegylated interferon alfa-2a or -2b with ribavirin. The hepatitis C virus provider should remain cognizant of the various organ systems that can be affected, which adverse effects should be addressed with the help of an expert, and the presentation of symptoms as they occur throughout the course of therapy. A systems-based approach should help to characterize the nature of the adverse effects that patients experience, and also to determine when patients should be further investigated by a consultant.
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Affiliation(s)
- Jihad Slim
- St. Michaels Medical Center, 111 Central Avenue, Newark, NJ 07102, USA.
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Abstract
In the last 2 decades the introduction new biologic agents such as tumor necrosis factor alpha inhibitors has resulted in potent disease modifying effects in a variety of immune-mediated diseases. In addition, there were major advancements in cancer treatment due to chemotherapeutic agents including granulocyte macrophage-colony-stimulating factor, interferon, epidermal growth factor receptor inhibitors, and kinase inhibitors for the treatment of hematologic malignancies as well as solid tumors. However, a variety of toxicities including cutaneous reactions is seen in association with these agents. Awareness of commonly associated skin toxicities and recognition of corresponding histologic features is of importance.
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Li Z, Ji F, Zheng Y, An J, Peng Z. Pegylated interferon, but not conventional interferon therapy induced severe skin lesions. Ann Hepatol 2012. [PMID: 22700642 DOI: 10.1016/s1665-2681(19)31475-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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Meyerson’s phenomenon in a patient affected by high-risk melanoma under treatment with interferon-α. Melanoma Res 2012; 22:284-5. [DOI: 10.1097/cmr.0b013e3283541563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A longitudinal cohort study of mucocutaneous drug eruptions during interferon and ribavirin treatment of hepatitis C. J Clin Gastroenterol 2012; 46:162-7. [PMID: 21814144 DOI: 10.1097/mcg.0b013e318228b5f6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
GOALS To describe dermatologic side effects encountered during treatment of patients with chronic hepatitis C, and analyze factors predisposing to such reactions. BACKGROUND Treatment of hepatitis C virus (HCV) infection with interferon (IFN) and ribavirin is associated with a number of mucocutaneous adverse reactions that have not been adequately studied. STUDY A retrospective cohort study design was used to longitudinally describe mucocutaneous drug eruptions during IFN and ribavirin therapy in HCV-infected patients. Factors predictive of mucocutaneous eruptions were analyzed by the use of Kaplan-Meier curves and Cox proportional hazard model. RESULTS A total of 286 HCV-infected consecutive patients were treated with one of the IFNα formulations plus ribavirin. The mean age was 51.1 years (SD 5.6). There were 6 female patients. There were 5 patients who were also infected with human immunodeficiency virus (HIV). Fifty-six percent of the patients were white, 37% were African American, and 14% were Hispanic. Twenty-one percent of all study patients developed mucocutaneous drug eruptions. The most common drug eruptions were eczematous drug eruptions (48%), seborrheic dermatitis (11%), and xerosis (8%). Dermatologic eruptions were a contributing factor in the decision to discontinue antiviral treatment in 10% of cases. Use of Pegylated IFN formulations (hazard ratio=1.86; 95% confidence interval, 1.04-3.34) and presence of HIV coinfection (hazard ratio=4.46; 95% confidence interval, 1.61-12.92) were associated with increased rate of skin reactions. CONCLUSIONS Mucocutaneous reactions during IFN and ribavirin treatment of hepatitis C are common and are associated with HIV infection and use of Pegylated IFN.
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Negro F. Adverse effects of drugs in the treatment of viral hepatitis. Best Pract Res Clin Gastroenterol 2010; 24:183-92. [PMID: 20227031 DOI: 10.1016/j.bpg.2009.10.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 10/01/2009] [Indexed: 01/31/2023]
Abstract
The hepatitis B virus (HBV) and the hepatitis C virus (HCV) affect approximately 400-500 million individuals worldwide. Both infections are characterised by a significant morbidity and mortality: chronic hepatitis B and C may evolve towards the development of cirrhosis and primary hepatocellular carcinoma. During the last two decades, several new antivirals have been developed that are active against HBV and HCV, allowing sustained cure rates in a significant proportion of patients. All these drugs have side effects, which may represent a major barrier to achieve cure in many patients in need. I will review the most common adverse events reported during the therapy of chronic hepatitis B and C, with some recommendations for proper management.
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Affiliation(s)
- Francesco Negro
- Divisions of Clinical Pathology, University Hospitals, 24 rue Micheli-du-Crest, 1211 Geneva 14, Switzerland.
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A review of adverse cutaneous drug reactions resulting from the use of interferon and ribavirin. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 23:677-83. [PMID: 19826642 DOI: 10.1155/2009/651952] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Drug-induced cutaneous eruptions are named among the most common side effects of many medications. Thus, cutaneous drug eruptions are a common cause of morbidity and mortality, especially in hospital settings. The present article reviews different presentations of drug-induced cutaneous eruptions, with a focus on eruptions reported secondary to the use of interferon and ribavirin. Presentations include injection site reactions, psoriasis, eczematous drug reactions, alopecia, sarcoidosis, lupus, fixed drug eruptions, pigmentary changes and lichenoid eruptions. Also reviewed are findings regarding life-threatening systemic drug reactions.
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Martins EV, Gaburri AK, Gaburri D, Sementilli A. Cutaneous Sarcoidosis: An Uncommon Side Effect of Pegylated Interferon and Ribavirin Use for Chronic Hepatitis C. Case Rep Gastroenterol 2009; 3:366-371. [PMID: 21103255 PMCID: PMC2988931 DOI: 10.1159/000251664] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The treatment of chronic hepatitis C (CHC) has evolved in the past 15 years and combination of pegylated interferon plus ribavirin is its current standard therapy. However, several side effects are commonly observed and frequently lead to transient or definitive interruption of treatment. Although sarcoidosis in its systemic or cutaneous form is a very rare side effect in such circumstances, some cases have been reported even with conventional interferon. This brief review of the literature and description of a case of sarcoidosis occurring in a tattoo and a scar patient's face, during treatment with pegylated interferon alpha-2b plus ribavirin, is an educative report directed in special to dermatologists. The lesion improved after drug interruption and recurred after retreatment with pegylated interferon alpha-2a. We conclude that this side effect must call the attention of doctors to seek for the diagnosis and therapy as soon as possible in such circumstances. No differences were noticed neither with alpha-2a nor alpha-2b pegylated interferon employment.
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Affiliation(s)
- Elson Vidal Martins
- Department of Gastroenterology and Hepatology, Metropolitan University of Santos, Santos, Brazil
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Sato M, Sueki H, Iijima M. Repeated episodes of fixed eruption 3 months after discontinuing pegylated interferon-alpha-2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus infection. Clin Exp Dermatol 2009; 34:e814-7. [PMID: 19817760 DOI: 10.1111/j.1365-2230.2009.03560.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a 73-year-old man who developed repeated episodes of erythematous, bullous plaques beginning 3 months after discontinuation of combination treatment with pegylated interferon (IFN)-alpha-2b and ribavirin for hepatitis C virus infection. The first episode resolved within a week without treatment, but the lesions recurred about once a month and were associated with high fever. Physical examination found darkly reddish, pigeon-egg-sized erythematous plaques with occasional flaccid blisters, predominantly on the trunk and proximal limbs, lip and penis. Histological examination showed well-demarcated foci of full-thickness epidermal necrosis and exocytosis of lymphoid cells. Pegylated IFN-alpha2b and ribavirin produced no response in lymphocyte stimulation tests. Systemic prednisolone led to rapid healing of skin lesions at the time of the fifth episode, leaving pigmented macules, but lesions recurred at the same sites within weeks of discontinuation of this treatment. It is uncertain whether this case represented a prolonged drug rash provoked by pegylated IFN-alpha2b or a fixed eruption in response to another antigen.
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Affiliation(s)
- M Sato
- Division of Dermatology, Showa University Fujigaoka Hospital, Yokohama, Japan
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Soutou B, Aractingi S. Myeloproliferative disorder therapy: assessment and management of adverse events--a dermatologist's perspective. Hematol Oncol 2009; 27 Suppl 1:11-3. [PMID: 19468982 DOI: 10.1002/hon.912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Development of cutaneous manifestations in patients with myeloproliferative disorders can be either due to the course of the disease itself or induced by some of the treatments given. The cutaneous manifestations may reveal an unknown haemopathy and/or indicate a poor prognosis. Some of these alter quality of life. Hydroxyurea has been shown to induce a variety of cutaneous adverse reactions ranging from benign effects such as hyperpigmentation to more severe leg ulcers and squamous cell carcinomas. Herein, we discuss the importance of undertaking regular physical examinations in order to identify and treat cutaneous manifestations early in their course.
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Guillermo N, Hernández Santana J, Borrego L, Jorge M. [Lichenoid eruption in a patient with chronic hepatitis C virus infection treated with interferon and ribavirin]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:130-131. [PMID: 19231693 DOI: 10.1016/j.gastrohep.2008.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 09/01/2008] [Indexed: 05/27/2023]
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Hashemi N, Rossi S, Navarro VJ, Herrine SK. Safety of peginterferon in the treatment of chronic hepatitis C. Expert Opin Drug Saf 2009; 7:771-81. [PMID: 18983223 DOI: 10.1517/14740330802423291] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Combination of 'pegylated' interferons (IFNs) plus ribavirin, the standard treatment of chronic hepatitis C (CHC), is frequently associated with side effects. Anticipation, recognition and proper management of these side effects are important to ensure compliance with therapy and achievement of sustained virologic response. OBJECTIVE To illustrate the side effect profile of pegIFN-alpha in the treatment of CHC. METHODS Studies and abstracts were identified through a computerized, English language literature search. Key search terms included peginterferon and CHC. Information available only in abstract form was retrieved from national and international hepatology associations. RESULTS Most adverse events occurring with combination therapy can be anticipated and managed appropriately; therefore, premature discontinuation of therapy owing to side effects is not required in most patients.
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Affiliation(s)
- Nikroo Hashemi
- Thomas Jefferson University, Division of Gastroenterology and Hepatology, Philadelphia, PA, USA
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LÜBBE J. Adverse skin reactions associated with hepatitis C treatment: Comment. J Dermatol 2008; 35:250; author reply 251. [DOI: 10.1111/j.1346-8138.2008.00458.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pegylated Interferons: Clinical Applications in the Management of Hepatitis C Infection. HEPATITIS C VIRUS DISEASE 2008. [PMCID: PMC7122148 DOI: 10.1007/978-0-387-71376-2_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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25
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Serarslan G, Okuyucu EE, Melek IM, Hakverdi S, Duman T. Widespread maculopapular rash due to intramuscular interferon beta-1a during the treatment of multiple sclerosis. Mult Scler 2007; 14:259-61. [DOI: 10.1177/1352458507079945] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a 41-year-old woman with multiple sclerosis, who presented erythematous maculopapular rash on the trunk and extremities after the second injection of interferon beta-1a. Histopathologic examination of the lesion revealed lymphocytic exocytosis and perivascular lymphocytic infiltrate in the dermis. Oral antihistamine and topical corticosteroid was started. After improvement of the lesions, the third injection was performed. However, the same reaction occurred. A prick test, which was performed 6 weeks after the eruption, also revealed positive reaction. Although injection-site reactions have been observed with interferon beta-1a, to our knowledge there have been no previous reports of interferon beta-1a-induced widespread cutaneous reaction. Multiple Sclerosis 2008; 14: 259—261. http://msj.sagepub.com
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Affiliation(s)
- G. Serarslan
- Department of Dermatology, Mustafa Kemal University, Faculty of Medicine, Antakya, Turkey,
| | - EE Okuyucu
- Department of Neurology, Mustafa Kemal University, Faculty of Medicine, Antakya, Turkey
| | - IM Melek
- Department of Neurology, Mustafa Kemal University, Faculty of Medicine, Antakya, Turkey
| | - S. Hakverdi
- Department of Pathology, Mustafa Kemal University, Faculty of Medicine, Antakya, Turkey
| | - T. Duman
- Department of Neurology, Mustafa Kemal University, Faculty of Medicine, Antakya, Turkey
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Hashimoto Y, Kanto H, Itoh M. Adverse skin reactions due to pegylated interferon alpha 2b plus ribavirin combination therapy in a patient with chronic hepatitis C virus. J Dermatol 2007; 34:577-82. [PMID: 17683392 DOI: 10.1111/j.1346-8138.2007.00336.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pegylated interferon (IFN)-alpha-2b with ribavirin has recently replaced "standard" IFN-alpha for the treatment of chronic hepatitis C. The most common side-effect of pegylated IFN-alpha-2b plus ribavirin combination therapy is localized inflammatory skin lesions at the site of injection. A 66-year-old female treated with once-weekly pegylated IFN-alpha-2b plus ribavirin for active chronic hepatitis C developed inflammatory skin lesions 2 months after starting antiviral treatment. The type of skin reactions observed were vesicle erythematous eruptions at the injection sites, and pruritic papular erythematous eruptions located on the face, neck, distal limbs, dorsa of the hands, trunk and buttocks away from the injection sites. Histological examination was performed on the pruritic papular erythematous eruption located on the left forearm, away from the injection sites. It showed epidermal spongiosis, a spongiotic microvesicle, and perivascular infiltration of the upper dermis with lymphocytes. The treatment was interrupted subsequently and the patient was rechallenged with pegylated IFN-alpha-2b plus ribavirin combination therapy, oral prednisolone with olopatadine hydrochloride and topical 0.1% diflucortolone valerate, which led to a significant improvement of skin lesions. Erythema with infiltration can occur at the injection sites of pegylated IFN-alpha-2b. However, the occurrence of vesicle erythematous eruptions away from the injection sites and autosensitization dermatitis apart from injection sites have not yet been frequently reported.
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Affiliation(s)
- Yuki Hashimoto
- The First Department of Dermatology, Toho University Omori Medical Center, Tokyo, Japan.
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Kartal ED, Alpat SN, Ozgunes I, Usluer G. Reversible alopecia universalis secondary to PEG-interferon alpha-2b and ribavirin combination therapy in a patient with chronic hepatitis C virus infection. Eur J Gastroenterol Hepatol 2007; 19:817-20. [PMID: 17700271 DOI: 10.1097/meg.0b013e32818b27e5] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Combined treatment with pegylated interferon (PEG-IFN) and ribavirin is currently recommended for the treatment of chronic hepatitis C virus (HCV) infection. Many side effects including hair disorders have, however, been reported related to this treatment. Alopecia universalis is a severe form of hair disorder. Three cases of alopecia universalis during PEG-IFN and ribavirin combination therapy have been reported in the literature. Herein is reported a case of reversible alopecia universalis, with complete hair loss extending to the whole body, secondary to PEG-IFN alpha-2b and ribavirin combination therapy for chronic HCV infection. Hair regrowth began within 3 months of the completion of combined therapy. In case the liver disease is advanced, and virologic response occurs, treatment can still be completed, as it appears that these side effects are reversible.
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Conde-Taboada A, de la Torre C, Feal C, Mayo E, Gonzalez-Sixto B, Cruces MJ. Meyerson's naevi induced by interferon alfa plus ribavirin combination therapy in hepatitis C infection. Br J Dermatol 2006; 153:1070-2. [PMID: 16225630 DOI: 10.1111/j.1365-2133.2005.06902.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Alpha interferon causes frequent and multiple cutaneous side effects that affect both the skin and mucous membranes. Patients receiving this treatment must be informed of the principal adverse reactions (dryness and hair loss or discoloration) and must receive care for them if the underlying treatment is to remain acceptable. Alpha interferon may induce, reveal, or worsen some dermatoses and related inflammatory disorders (atopic dermatitis, psoriasis, sarcoidosis).
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Affiliation(s)
- V Descamps
- Service de dermatologie, Hôpital Bichat, APHP, 46, rue Henri Huchard, 75018 Paris.
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Lübbe J, Kerl K, Negro F, Saurat JH. Clinical and immunological features of hepatitis C treatment-associated dermatitis in 36 prospective cases. Br J Dermatol 2005; 153:1088-90. [PMID: 16225644 DOI: 10.1111/j.1365-2133.2005.06931.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Savk E, Uslu G, Karaoğlu AO, Sendur N, Karaman G. Diffuse cutaneous eruption due to interferon alfa and ribavirin treatment of chronic hepatitis C. J Eur Acad Dermatol Venereol 2005; 19:396-8. [PMID: 15857485 DOI: 10.1111/j.1468-3083.2004.01143.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
A 32-year-old woman with multiple sclerosis who developed non-injection-site-related fixed drug eruption with interferon-beta-1b. Erythematous plaques started appearing 1 month after the drug was introduced, and increased in number following each administration. The histopathology of a skin biopsy was consistent with fixed drug eruption. The drug was subsequently ceased, with resolution of the rash 6 weeks later.
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Affiliation(s)
- Yee J Tai
- Department of Dermatology, St. Vincent's Hospital, Melbourne, Victoria, Australia.
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Girard C, Bessis D, Blatìre V, Guilhou JJ, Guillot B. Meyerson's phenomenon induced by interferon-alfa plus ribavirin in hepatitis C infection. Br J Dermatol 2005; 152:182-3. [PMID: 15656829 DOI: 10.1111/j.1365-2133.2004.06324.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We report a case of severe lichenoid drug eruption with multiple possible causative agents. A hepatitis C-positive male presented with a short history of painful erosions of the vermilion, lichenoid lesions on the buccal mucosa and glans penis, and erosions and lichenification of the scrotum. In addition, he had a pruritic polymorphic eruption over the scalp, trunk and limbs, comprising psoriasiform and eczematous lesions. He had received combination therapy of pegylated interferon-alpha-2a and ribavirin, along with granulocyte colony-stimulating factor for interferon-induced leucopenia, and propranolol for portal hypertension. The former three agents were ceased 3 weeks prior to presentation, but he remained on propranolol at the initial dermatology consultation. The polymorphous clinical picture was consistent with lichenoid drug eruption, which was confirmed on histology. The papulosquamous eruption responded quickly to 2 weeks of oral prednisone 25 mg daily, which was tapered to 1 mg over 3 months and then ceased. The mucosal lesions were slow to improve and required the addition of tacrolimus 0.03% solution t.d.s. for complete resolution.
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Affiliation(s)
- Katherine Armour
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Ruiz de Casas A, García-Bravo B, Camacho F. Eczema generalizado secundario a tratamiento combinado con interferón alfa-2a pegilado y ribavirina en un paciente con hepatitis crónica por virus de la hepatitis C. ACTAS DERMO-SIFILIOGRAFICAS 2005; 96:122-3. [PMID: 16476350 DOI: 10.1016/s0001-7310(05)73051-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Adverse skin effects from interferon (IFN) plus ribavirin combined therapy are relatively frequent, but they are usually local and related to the IFN injection site. However, distant or generalized eczematous reactions secondary to this treatment are rare. The introduction of pegylated interferons may increase the frequency of these skin lesions.
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Affiliation(s)
- Andrés Ruiz de Casas
- Departamento de Dermatología MQ, Hospital Virgen Macarena, Avda. Dr. Fedriani s/n, 41009 Seville, Spain.
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36
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Adverse cutaneous reactions to interferon alfa. J Am Acad Dermatol 2005. [DOI: 10.1016/j.jaad.2004.10.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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39
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Guillot B, Blazquez L, Bessis D, Dereure O, Guilhou JJ. A prospective study of cutaneous adverse events induced by low-dose alpha-interferon treatment for malignant melanoma. Dermatology 2004; 208:49-54. [PMID: 14730237 DOI: 10.1159/000075046] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 08/08/2003] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION alpha-Interferon is associated with numerous cutaneous side effects, but the accurate incidence of these complications is not clearly known. OBJECTIVES A prospective study was designed to evaluate the incidence and clinical pattern of cutaneous side effects in a cohort of patients receiving adjuvant therapy with low-dose interferon for malignant melanoma. MATERIAL AND METHODS A cohort of 33 patients with stage IIA and IIB melanoma treated with low-dose alpha-interferon (3 MIU 3 times a week for 18 months) were prospectively enrolled in a single-center study. The patients responded to a questionnaire on their medical history and were systematically examined for any cutaneous lesions before treatment and every 3 months afterwards. RESULTS 29/33 patients (87%) experienced 1 or more cutaneous side effects. The most frequent was hair loss and occurred in 16 cases (48.4%). Hair discoloration was noted in 6 cases (18%). Eczematous reactions at injection sites or at remote sites were observed in 13 patients (39%). Pruritus occurred in 10 cases (30%). Xerostomia, Raynaud's phenomenon or livedo reticularis were observed in 10 patients, associated with an increase in circulating autoantibody titer in 2 cases. Some rare side effects were observed: urticaria (1 case) or angioedema (1 case), worsening of preexisting seborrheic dermatitis (3 cases), herpetic recurrence (2 cases), pityriasis versicolor (1 case), worsening of recurrent buccal aphthous ulcer (1 case) and vitiligo (1 case). CONCLUSION Cutaneous adverse events during adjuvant immunotherapy of melanoma with low-dose alpha-interferon seem to be frequent but do not result in treatment discontinuation. A good awareness of these side effects may be useful for a more accurate survey and clinical management of patients receiving this treatment.
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Affiliation(s)
- B Guillot
- Service de Dermatologie, Hôpital Saint-Eloi, CHU de Montpellier, Montpellier, France.
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Vázquez-López F, Manjón-Haces JA, Pérez-Alvarez R, Pérez-Oliva N. Eczema-like lesions and disruption of therapy in patients treated with interferon-alfa and ribavirin for chronic hepatitis C: the value of an interdisciplinary assessment. Br J Dermatol 2004; 150:1046-7; author reply 1047. [PMID: 15149535 DOI: 10.1111/j.1365-2133.2004.05957.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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41
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Lubbe J, Negro F, Bullani-Kerl K. Eczema-like lesions and disruption of therapy in patients treated with interferon-alfa and ribavirin for chronic hepatitis C: the value of an interdisciplinary assessment: reply from authors. Br J Dermatol 2004. [DOI: 10.1111/j.1365-2133.2004.05956.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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42
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Kerl K, Negro F, Lübbe J. Cutaneous side-effects of treatment of chronic hepatitis C by interferon alfa and ribavirin. Br J Dermatol 2003; 149:656. [PMID: 14511009 DOI: 10.1046/j.1365-2133.2003.05481.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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