Reversible Alopecia Universalis During Treatment with PEG-Interferon and Ribavirin for Chronic Hepatitis C

Abstract

The combination of PEG-interferon and ribavirin is currently recommended for the treatment of chronic hepatitis C, which is a common cause of morbidity and mortality worldwide. Hair disorders have often been described during interferon therapy, which include reversible hair discoloration, hypertricosis and alopecia. Ribavirin is reported to cause photoallergic reactions. We report two cases of alopecia universalis, with complete hair loss extended to the whole body, secondary to PEG-interferon and ribavirin combination therapy for chronic hepatitis C virus infection. Both female patients were infected by genotype 1 and presented alopecia during the second half of a 48-week therapy, concurrently with low levels of ferritin and thyroid dysfunction (patient 1) or depression (patient 2). Patient 1 withdrew from the therapy on week 26 and, due to the occurrence of maculo-erythematous cutaneous eczema, underwent corticosteroid therapy with complete hair regrowth. Patient 2 completed the scheduled therapy and showed a spontaneous complete hair regrowth. It should be noted that in spite of an early (within 4 weeks of therapy) virological response, patient 1 had a disease relapse after therapy withdrawal and corticosteroid therapy, while patient 2 maintained a sustained virological response. In conclusion, interferon therapy may trigger reversible alopecia universalis in susceptible patients. However, given the benign and reversible nature of this side effect, patients who achieve a virological response should be strongly advised to complete the treatment in order to prevent disease relapse.

Cutaneous Reactions to Novel Therapeutics

“…[79][80][81][82] Alopecia has been reported in 19% of patients treated with combination interferon and ribavirin, 83 including alopecia areata 84,85 and alopecia universalis. [86][87][88] Vitiligo has been reported in a number of patients who were treated for Hepatitis C with interferron. 89 Cases of cutaneous necrosis, 90,91 fixeddrug eruption, 92,93 lichenoid eruptions [94][95][96][97][98] (Fig.…”

Pityriasis Rosea in a Hepatitis B-Positive Patient Treated with Pegylated Interferon α_2a: Report of a Case and Review of the Literature

“…Several reports in the literature have suggested a possible association between PEG-IFN-α therapy, sarcoidosis and morbilliform eruptions [14,15,16,17]. However, cutaneous drug reactions are more common with PEG-IFN-α 2a plus ribavirin combination therapy [6,7,8,9]. Sometimes, it is possible to continue treatment after switching from PEG-IFN to conventional IFN.…”

“…Pegylated (PEG) or non-PEG α-interferon (IFN-α) is a frequently used treatment for both chronic hepatitis B and chronic hepatitis C. Cutaneous side effects of IFN-based treatments, when they occur, can sometimes cause therapy discontinuation. Skin reactions are the most frequently seen side effects also during PEG-IFN plus ribavirin combination therapy [6,7,8,9]. It is still poorly understood if such manifestations could be triggered by some PEG component or by imbalance of cellular immunity and control of latent viral infections.…”

Cytokines Induced Skin Adverse Reactions

“…• Polyethylene glycol (PEG)-containing product, seems to induce more frequent adverse reactions and a large number of side-effect cases related to combination therapy with ribavirin have been reported [65][66][67][68][69].…”