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

Abstract

Chronic hepatitis C infection (CHC) is acknowledged as a major health problem all over the world. The World Health Organization estimates that 3-4 million individuals are infected each year worldwide, with a global 170 million chronic HCV carriers at risk of developing liver cirrhosis and/or liver cancer. The most experienced treatment for chronic hepatitis C is pegylated interferon (PEGINF) and ribavirin (RBV) combination therapy. A variety of conditions ranging from endocrinopathies to different skin diseases have been described in only HCV infections and/or associated with IFN based therapy. The skin lesion during anti-HCV therapy rate is 24-28%, according to randomized controlled clinical trials. The incidence of cutaneous eruptions has been estimated to be 13% to 23%. Alopecia is a frequent adverse effect of interferon and ribavirin treatment in 19% of patients treated with combination therapy. Several types of alopecia exist; telogen effluvium, localized alopecia at the injection site AA (Alopeciae Areata) and AU (Alopeciae Universalis) have been described. Telogen effluvium (TE) is characterized by an excessive loss of telogen hair. It occurs in about 30% of patients who are treated with IFN. Anagen effluvium (AE) is the non-reported case in literature in terms of the PEG-IFN and RBV combination therapy for chronic HCV infection induced anagen alopecia. Herein, we are present a case of dystrophic TE which was attributed to the INF/ribavirin combination therapy, and interpretation of the case according to hertrichogram findings. To the best of our literature search, our patient is the first case in terms of extensively interpreted with both clinical and trichogram features of a PEG-INF/ribavirin induced alopecia.