1
|
Houlihan OA, Rangaswamy G, McArdle O. A rare case of melanotic hyperpigmentation of the tongue secondary to radiotherapy. Rep Pract Oncol Radiother 2021; 26:320-323. [PMID: 34211784 DOI: 10.5603/rpor.a2021.0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 02/03/2021] [Indexed: 11/25/2022] Open
Abstract
Melanotic hyperpigmentation of the mucosa secondary to radiotherapy is a rare occurrence. It is a diagnosis of exclusion. Literature review has identified only two case reports published to date. We present a case of a patient treated at our institution. An 18-year-old male patient of Nigerian descent underwent radical radiotherapy (36 Gy in 18 daily fractions) to his right neck for paediatric type follicular lymphoma over a period of four weeks. He developed hyperpigmented tongue lesions during the third week of radiotherapy. There was no associated tongue discomfort, inflammation, infection, or pigmentation change elsewhere in the oral mucosa. Review of medications and past medical history did not demonstrate any potential contributing factors. Full blood count and biochemistry, morning cortisol levels and coagulation screen were all normal apart from mild neutropenia and lymphopenia. His oral cavity received a mean dose of 16.4 Gy, with the right side of his tongue receiving up to 37.5 Gy as this was within the planning target volume (PTV). He had an excellent response to radiotherapy and remains in remission. The tongue lesions resolved spontaneously 3 months post treatment.
Collapse
Affiliation(s)
| | | | - Orla McArdle
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| |
Collapse
|
2
|
Tawfik YM, Hassany SM, Badran AY, El-Gazzar AF, Alemam MF, Sayed DS. Hepatitis C virus associated skin manifestations in upper Egypt: Before and after direct acting antiviral treatment. Dermatol Ther 2020; 33:e14365. [PMID: 33001546 DOI: 10.1111/dth.14365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 12/27/2022]
Abstract
Egypt displays a high-hepatitis C virus (HCV) burden and almost 20% of the patients develop cutaneous manifestations HCV-related. Direct acting antivirals (DAAs) drastically changed HCV patient's morbidity and mortality but their impact of the cutaneous manifestations remains elusive. Our aim was to find out the prevalence of different dermatological manifestations accompaning HCV infection in Egyptian patients. Also, to highlight the impact of DAAs on such manifestations and any potential dermatological side effects. A descriptive study was carried out at the Department of Tropical medicine and Gastroenterology in collaboration with the Department of Dermatology, Venerology and Andrology, Assiut University Hospitals. Medical history, full general, dermatological examination and photography were performed for all patients before the start of treatment with the full regimen of DAAs, every month and 3 months after reaching sustained virological response (SVR), and the changes of skin lesions were recognized and rated by two blinded dermatologists. Out of 1000 examined patient, 36.9% had skin manifestation. Itching was the commonenst presented in 190 patients (51.5%). Three months after reaching SVR, skin examination revealed improvement in the majority of patients (23 764.22%). Pruritis had significant clinical improvement in 152(80%) of patients with significant change in the Visual Analog Score (P = .000). Also, patients with both cutaneous vasculitis and eczema experienced improvement in their skin manifestations. Skin manifestations are common in Egyptian patients with HCV infection. Pruritis is the commonest. The use of DAAs in treatment of HCV is associated with significant improvement of skin lesions with very limited cutaneous adverse effects.
Collapse
Affiliation(s)
- Yasmin Mostafa Tawfik
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Sahar M Hassany
- Department of Tropical medicine and Gastroenterology, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Aya Y Badran
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Amira F El-Gazzar
- Department of Public Health and Community Medicine, Assiut University, Assuit, Egypt
| | - Mohamed F Alemam
- Department of Clinical pathology, Quena faculty of Medicine, South Valley University, South Valley University, Qena, Egypt
| | - Doaa S Sayed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assuit University, Assuit, Egypt
| |
Collapse
|
3
|
Li C, Geng H, Ji L, Jiang Y, Ma X, Yin Q, Xiong H. Severe polymorphic erythema due to interferon α-2b during treatment of hairy cell leukemia. J Int Med Res 2019; 47:3453-3457. [PMID: 31248295 PMCID: PMC6683944 DOI: 10.1177/0300060519856158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A 54-year-old woman with hairy cell leukemia developed severe polymorphic erythema and blisters on the trunk and limbs after injection of interferon (IFN) α-2b. Skin biopsy revealed lymphocytic exocytosis and perivascular lymphocytic infiltrate in the dermis, and the lesions improved after methylprednisolone pulse therapy. Although injection-site reactions have been observed after injection of IFNα-2b, this is the first report of a widespread cutaneous reaction to IFNα-2b.
Collapse
Affiliation(s)
- Chen Li
- 1 Qinghai University Graduate School, Xining, China
| | - Hui Geng
- 2 Department of Haematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Linhua Ji
- 2 Department of Haematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Yan Jiang
- 2 Department of Haematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Xiaojing Ma
- 2 Department of Haematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Qichao Yin
- 2 Department of Haematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| | - Hua Xiong
- 2 Department of Haematology, the Affiliated Hospital of Qinghai University, Xining, Qinghai, China
| |
Collapse
|
4
|
The immunology and inflammatory responses of human melanocytes in infectious diseases. J Infect 2015; 71:413-21. [PMID: 26092350 DOI: 10.1016/j.jinf.2015.06.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/06/2015] [Accepted: 06/10/2015] [Indexed: 12/24/2022]
Abstract
Melanin is a canonical and major defense molecule in invertebrates but its role in mammalian immunity remains unexplored. In contrast, several recent studies have highlighted the emerging innate immune activities of human melanin-producing cells which can sense and respond to bacterial and viral infections. Indeed, the skin is a major portal of entry for pathogens such as arboviruses (Chikungunya, Dengue) and bacteria (mycobacterium leprae, Leptospira spirochetes). Melanocytes of the epidermis could contribute to the phagocytosis of these invading pathogens and to present antigens to competent immune cells. Melanocytes are known to produce key cytokines such as IL-1β, IL6 and TNF-α as well as chemokines. These molecules will subsequently alert macrophages, neutrophils, fibroblasts and keratinocytes through unique crosstalk mechanisms. The infection and the inflammatory responses will control melanocyte's immune and metabolic functions and could contribute to skin manifestations (rash, hyper or de-pigmentation, epidermolysis and psoriasis-like lesions). This review will address the potential role of melanocytes in immunity, inflammation and infection of the skin in health and diseases.
Collapse
|
5
|
Hepatitis C virus treatment with pegylated interferon-alfa therapy leading to generalized interstitial granuloma annulare and review of the literature. Am J Ther 2014; 20:585-7. [PMID: 21317616 DOI: 10.1097/mjt.0b013e318209e049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We discuss the diagnosis and management of a case of generalized granuloma annulare (GA) occurring in a 49-year-old man when being treated with pegylated interferon-alfa for hepatitis C infection. In our case, the GA lesions remained despite an undetectable hepatitis C viral load. The GA resolved only with treatment cessation.
Collapse
|
6
|
Pigmentación oral asociada al tratamiento con alfa-interferón y ribavirina para la hepatitis C. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:211-2. [DOI: 10.1016/j.ad.2013.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/17/2013] [Accepted: 01/20/2013] [Indexed: 11/21/2022] Open
|
7
|
Oral Hyperpigmentation Associated With Interferon-Alpha and Ribavirin Therapy for Hepatitis C Virus Infection. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
8
|
Alfreijat M. Tongue hyperpigmentation associated with chemotherapy. J Community Hosp Intern Med Perspect 2013; 3:21047. [PMID: 24392209 PMCID: PMC3879509 DOI: 10.3402/jchimp.v3i3-4.21047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/14/2022] Open
Affiliation(s)
- Majd Alfreijat
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
9
|
López Peláez MV, González Díaz P, Téllez Molina MJ, Vergas García J. [Lingual hyperpigmentation in a patient with chronic infection]. Enferm Infecc Microbiol Clin 2012; 31:264-5. [PMID: 23260387 DOI: 10.1016/j.eimc.2012.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/12/2012] [Accepted: 10/23/2012] [Indexed: 11/26/2022]
Affiliation(s)
- María Vanessa López Peláez
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna III, Hospital Clínico San Carlos, Madrid, Spain.
| | | | | | | |
Collapse
|
10
|
Mlika RB, Kerkeni N, Marrak H, Fenniche S, Mokhtar I, Debbiche A. Tongue hyperpigmentation during PEG-interferon-alfa/ribavirin therapy in a non-Caucasian patient with chronic hepatitis C: a case report and review of the literature. Int J Dermatol 2012; 52:643-4. [PMID: 23046405 DOI: 10.1111/j.1365-4632.2011.04921.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
11
|
|
12
|
|
13
|
Tongue hyperpigmentation resulting from peginterferon alfa-2b and ribavirin treatment in a patient with chronic hepatitis C. Dig Dis Sci 2012; 57:820-1. [PMID: 21948358 DOI: 10.1007/s10620-011-1914-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 09/04/2011] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) infection has been associated with several cutaneous diseases such as lichen planus, porphyria cutanea tarda, chronic pruritus, and cutaneous necrotizing vasculitis (Doutre, Arch Dermatol 135:1401-1403, 1999). The antiviral treatment for chronic HCV with interferon alfa (INF) or peginterferon alfa (PEG-INF) combined with rivabirin also leads to many skin side effects including injection site reaction, generalized skin rashes, pruritus, dry skin, alopecia, and exacerbation of autoimmune processes, particularly psoriasis, lichen planus or vitiligo (Dalekos et al., Eur J Gastroenterol Hepatol 10:933-939, 1998; Sookoian et al., Arch Dermatol 135:1000-1000, 1999). There are case reports of tongue hyperpigmentation during combination therapy of PEG IFN and RBV in chronic hepatitis C both in dark-skined as well as Caucasian. We report the first case of tongue hyperpigmentation associated with PEG-INF-2b plus ribavirin administration in a non-Caucasian patient with genotype 4.
Collapse
|
14
|
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.
Collapse
|
15
|
Cunha VS, Meotti C, Oliveira JH, Sprinz E, Alvares-da-Silva MR, Goldani LZ. Different patterns of dermatological presentations in patients co-infected with human immunodeficiency virus and hepatitis C virus (HCV), and those infected with HCV alone. Clin Exp Dermatol 2011; 37:122-7. [PMID: 22103463 DOI: 10.1111/j.1365-2230.2011.04217.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: 12/20/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the same transmission routes. About 30% of HIV-positive patients are co-infected with HCV. Of the various HCV-related extrahepatic events, those involving the skin may be the first sign of infection. AIM To specify the skin presentations in patients co-infected with HIV and HCV (co-infected patients; CP) and compare them with those found in patients with HCV mono-infection (mono-infected patients; MP). METHODS This was a cross-sectional study, in which the studied population consisted of MP and CP from a tertiary hospital in the South of Brazil, who underwent complete skin examination and laboratory tests. RESULTS In total, 201 patients were assessed, of whom 108 were CP, and 93 were MP. Pruritus tended to be more common in MP. MP also had significantly more dermatological conditions (mean of 5.2) than CP (mean of 4.5). In total, 104 different skin diseases were identified. There was a higher prevalence of infectious diseases and pigmentation disorders, such as verruca vulgaris and facial melasma, in CP, whereas trunk and facial telangiectasias, palmar erythema, and varicose veins were more common in MP. CONCLUSION We found a high prevalence of skin conditions both in MP and in CP; however, the patterns of the dermatological conditions were different. CP were found to have significantly fewer skin lesions than MP, but had a higher prevalence of infectious and pigmentation disorders. By contrast, vascular conditions were more common in MP.
Collapse
Affiliation(s)
- V S Cunha
- Section of Dermatology, Internal Medicine Department, Universidade Federal do Santa Catarina, Florianópolis, Santa Catarina, Brazil.
| | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Abstract
Black hairy tongue (BHT) is a benign, self-limiting disorder characterized by abnormally hypertrophied and elongated filiform papillae on the surface of the tongue. The prevalence of BHT is quite variable, ranging from 0-53.8% depending on the population. Many predisposing factors to BHT exist, and several drugs and drug classes have been implicated in causing this disorder. A modified Naranjo adverse drug reaction probability nomogram specific for BHT was used to rate causality for the available published case reports of drug-induced BHT. From the available data, antibiotics and drugs capable of inducing xerostomia are the drug classes that have modest evidence of causality and a rational mechanism. The presence of underlying predisposing factors in these cases along with the variable prevalence of BHT make drawing firm conclusions difficult. Treatment for BHT involves eliminating any predisposing issues and practicing scrupulous oral hygiene. Drug therapy and physical removal of the elongated filiform papillae are available for resistant cases. Clinicians should be aware of the prevalence, the predisposing factors and drug classes that may play a role in the development, and the treatment of BHT.
Collapse
Affiliation(s)
- Dennis F Thompson
- Department of Pharmacy Practice, Southwestern Oklahoma State University, Weatherford, Oklahoma 73103, USA.
| | | |
Collapse
|
18
|
|
19
|
Farshidi D, Chiu MW. Lingual hyperpigmentation from pegylated interferon and ribavirin treatment of hepatitis C. J Am Acad Dermatol 2010; 62:164-165. [PMID: 20082904 DOI: 10.1016/j.jaad.2009.03.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/23/2009] [Accepted: 03/23/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Dina Farshidi
- Division of Dermatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | - Melvin W Chiu
- Division of Dermatology, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California.
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Tongue hyperpigmentation resulting from peginterferon alfa and ribavirin combination therapy: a case report. J Am Dent Assoc 2009; 140:1377-9. [PMID: 19884395 DOI: 10.14219/jada.archive.2009.0073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Tongue hyperpigmentation is a rare side effect in patients with hepatitis C virus infection who are receiving peginterferon alfa and ribavirin combination therapy. Tongue hyperpigmentation usually occurs after the patient has undergone several months of treatment, and it resolves after the patient discontinues therapy. CASE DESCRIPTION A 66-year-old dark-skinned woman with hepatitis C virus infection was referred to the Oral Diseases Treatment Center of São Leopoldo Mandic Dental School, Campinas, Brazil, for evaluation of tongue pigmentation after receiving peginterferon alfa and ribavirin combination therapy for 32 weeks. A physical examination showed dark brown, asymptomatic pigmentation in the dorsum of the tongue. Six months after the patient discontinued therapy, the authors observed a marked reduction in the pigmentation's intensity. CASE IMPLICATIONS Dentists should be aware that hyperpigmentation of the tongue can result from peginterferon alfa and ribavirin combination therapy. A biopsy should be performed if no firm diagnosis can be obtained from clinical findings and the patient's medical history.
Collapse
|
22
|
Lin J, Lott JP, Amorosa VK, Kovarik CL. Iatrogenic hyperpigmentation in chronically infected hepatitis C patients treated with pegylated interferon and ribavirin. J Am Acad Dermatol 2009; 60:882-3. [DOI: 10.1016/j.jaad.2008.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 08/25/2008] [Accepted: 10/03/2008] [Indexed: 11/29/2022]
|
23
|
Fernández A, Vázquez S, Rodríguez-González L. Tongue hyperpigmentation resulting from peginterferon alpha-2a and ribavirin treatment in a Caucasian patient with chronic hepatitis C. J Eur Acad Dermatol Venereol 2008; 22:1389-91. [PMID: 18355209 DOI: 10.1111/j.1468-3083.2008.02653.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
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.
Collapse
Affiliation(s)
- Yuki Hashimoto
- The First Department of Dermatology, Toho University Omori Medical Center, Tokyo, Japan.
| | | | | |
Collapse
|
25
|
Torres HA, Bull L, Arduino RC, Barnett BJ. Tongue hyperpigmentation in a caucasian patient coinfected with HIV and hepatitis C during peginterferon alfa-2b and ribavirin therapy. Am J Gastroenterol 2007; 102:1334-5. [PMID: 17531028 DOI: 10.1111/j.1572-0241.2007.01162.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
26
|
Berk DR, Mallory SB, Keeffe EB, Ahmed A. Dermatologic disorders associated with chronic hepatitis C: effect of interferon therapy. Clin Gastroenterol Hepatol 2007; 5:142-51. [PMID: 16919505 DOI: 10.1016/j.cgh.2006.06.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Chronic hepatitis C virus infection (HCV) is associated with extrahepatic manifestations, including such dermatologic conditions as mixed cryoglobulinemia, porphyria cutanea tarda, and lichen planus. Patients with chronic HCV and extrahepatic manifestations are often excluded from clinical trials evaluating interferon (IFN) therapy due to concerns about poor response, adverse events, and toxicity. Thus, data regarding the efficacy of IFN not only on the underlying chronic HCV, but also on extrahepatic manifestations, are limited in these patients. Case reports suggest that the response of dermatologic extrahepatic manifestations to IFN in patients with chronic HCV is highly variable. This review summarizes available data on dermatologic conditions associated with chronic HCV and their response to IFN therapy.
Collapse
Affiliation(s)
- David R Berk
- Division of Dermatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | | | | |
Collapse
|
27
|
Basaranoglu M, Celebi S, Karaaslan H, Demir A. Case study on drug-related adverse effects of hepatitis C therapy. Adv Ther 2006; 23:769-71. [PMID: 17142211 DOI: 10.1007/bf02850316] [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: 11/29/2022]
Abstract
The case of a 46-year-old woman with chronic hepatitis C who was prescribed subcutaneous pegylated interferon once a week and oral ribavirin once a day is presented. Within 24 h after the first injection to her left arm, the patient developed pruritus and erythematous papules at the injection site and painful papules on her hands. After immediate administration of antihistamines, the pruritus and papules remitted. One wk later, after injection in the right arm, skin lesions and pruritus were seen. After the third injection to the abdomen, the patient developed a rash, and after the fourth and fifth injections to other areas of the abdomen, injection-site papules were seen. The patient had no skin reactions for the next 12 mo, with the exception of injection-site papules. Hepatitis C virus RNA was negative after 12 mo of treatment. Clearly, patience is important during hepatitis C therapy in order to avoid unnecessary examinations and to promote successful outcomes.
Collapse
Affiliation(s)
- Metin Basaranoglu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Selcuk University School of Medicine, Konya, Turkey
| | | | | | | |
Collapse
|
28
|
Gurguta C, Kauer C, Bergholz U, Formann E, Steindl-Munda P, Ferenci P. Tongue and skin hyperpigmentation during PEG-interferon-alpha/ribavirin therapy in dark-skinned non-Caucasian patients with chronic hepatitis C. Am J Gastroenterol 2006; 101:197-8. [PMID: 16405555 DOI: 10.1111/j.1572-0241.2005.00323.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Various skin disorders may occur during antiviral therapy with interferon (IFN) and ribavirin (RBV) for chronic hepatitis C. This article describes to our knowledge the first report of lingual hyperpigmentation during pegylated (PEG)-IFN/RBV combination therapy in five dark-skinned hepatitis C virus (HCV) patients. Lingual pigmentation during antiviral therapy was not associated with age, gender, HCV genotype, doses of RBV, or duration of the treatment or treatment outcome. Since IFN increases the expression of alpha-melanocyte-stimulating hormone (MSH) surface receptors, the use of PEG-IFN having a longer plasma half-life may even increase incidence for such cutaneous side effects particularly in dark-skinned HCV patients.
Collapse
Affiliation(s)
- Calin Gurguta
- Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | |
Collapse
|
29
|
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]
|
30
|
Slominski A, Tobin DJ, Shibahara S, Wortsman J. Melanin pigmentation in mammalian skin and its hormonal regulation. Physiol Rev 2004; 84:1155-228. [PMID: 15383650 DOI: 10.1152/physrev.00044.2003] [Citation(s) in RCA: 1350] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cutaneous melanin pigment plays a critical role in camouflage, mimicry, social communication, and protection against harmful effects of solar radiation. Melanogenesis is under complex regulatory control by multiple agents interacting via pathways activated by receptor-dependent and -independent mechanisms, in hormonal, auto-, para-, or intracrine fashion. Because of the multidirectional nature and heterogeneous character of the melanogenesis modifying agents, its controlling factors are not organized into simple linear sequences, but they interphase instead in a multidimensional network, with extensive functional overlapping with connections arranged both in series and in parallel. The most important positive regulator of melanogenesis is the MC1 receptor with its ligands melanocortins and ACTH, whereas among the negative regulators agouti protein stands out, determining intensity of melanogenesis and also the type of melanin synthesized. Within the context of the skin as a stress organ, melanogenic activity serves as a unique molecular sensor and transducer of noxious signals and as regulator of local homeostasis. In keeping with these multiple roles, melanogenesis is controlled by a highly structured system, active since early embryogenesis and capable of superselective functional regulation that may reach down to the cellular level represented by single melanocytes. Indeed, the significance of melanogenesis extends beyond the mere assignment of a color trait.
Collapse
Affiliation(s)
- Andrzej Slominski
- Dept. of Pathology, Suite 599, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN 38163, USA.
| | | | | | | |
Collapse
|