Irreversible alopecia universalis during treatment with pegylated interferon–ribavirin for chronic hepatitis C virus infection: Case report and published work review

Abstract

Hair disorders that have been described in association with pegylated interferon-ribavirin combination treatment include canities, hypertrichosis, telogen effluvium, and the most common cutaneous side-effect by far, alopecia. Alopecia is a heterogeneous disease characterized by hair loss on the scalp or any hair-bearing surface with a wide range of clinical presentations, from a single patch of hair loss to complete loss of hair on the entire body (alopecia universalis). Although some cases of reversible alopecia universalis associated with pegylated interferon-ribavirin combination therapy have been reported in the published work, irreversible alopecia universalis has not yet been reported in relation to pegylated interferon and ribavirin combination treatment. For the first time, we report a case of irreversible alopecia universalis during pegylated interferon-ribavirin combination therapy in a man infected with hepatitis C virus in the absence of clinical or biochemical evidence of immunological disorders or thyroid dysfunction at any time before, during or after antiviral therapy.

Widespread Dystrophic-Anagen Alopecia and Drug Eruption due to Usage of PEG-IFN ?-2a /Ribavirin Combination Therapy

“…Skin lesions may vary in severity from localized rash to diffuse skin eruption [1]. Furthermore, there have been some reports of drug eruption or alopecia caused by ribavirin and PEG-IFN-α2b or IFN-α combination therapy [1,2,5,7].…”

“…The incidence of cutaneous eruptions has been estimated to be 13% to 23% [2]. Lots of hair disorders, including reversible hair discoloration, hypertrichosis, straight hair and effluvium (alopecia), and diffuse thinning of the hair, hair curling, repigmentation of hair, trichomegaly of the eyelashes have often been described during IFN therapy [3][4][5]. Alopecia is a frequent adverse effect of interferon and ribavirin treatment in 19% of patients treated with combination therapy.…”

“…It seems that the incidence of alopecia increases with the duration of treatment and usually is noticed in up to 36% of treated patients in pivotal clinical trials [6]. Among the clinical types of alopecia, telogen effluvium (TE), localized alopecia (LA) at the injection site, alopecia areata (AA) and alopecia universalis (AU) have been described [5,[7][8][9][10]. TE is characterized by an excessive loss of telogen hair.…”

“…TE is characterized by an excessive loss of telogen hair. It occurs in about 30% of patients who are treated with IFN [5,8,11]. LA is characterized by the local loss of hair at the injection site.…”

“…It develops secondary to the inflammation at the injection site. AA is characterized by circumscribed, noninflammatory and nonscarring alopecic patches on the scalp [5,8,11]. AU, which is defined as complete hair loss extending to the whole skin, is a severe form of AA [7].…”