Adverse skin reactions due to pegylated interferon alpha 2b plus ribavirin combi

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Adverse skin reactions due to pegylated interferon alpha 2b plus ribavirin

combination therapy in a patient with chronic hepatitis C virus

Authors: HASHIMOTO, Yuki; KANTO, Hiromi; ITOH, Masatoshi

Source: Journal of Dermatology, Volume 34, Number 8, August 2007 , pp.

577-582(6)

Publisher: Blackwell Publishing

Abstract:

Pegylated interferon (IFN)-á-2b with ribavirin has recently replaced

“standard” IFN-á for the treatment of chronic hepatitis C. The most common

side-effect of pegylated IFN-á-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-á-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-á-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-á-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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