Skin As A Reflection Of Hepatitis C Virus Infection And Adverse Effects Of Its Treatment

摘要

Sir,Hepatitis C viral infection (HCV) is a major global health concern with 170 million people affected worldwide there are estimated 12 -13 million carriers in India presently1. Currently the combination of peg interferon and ribavarin is considered the standard treatment of HCV infection2. Although combination of these two drugs is most effective but it is also associated with increased risk of side effects due to immunomodulatory effect of both the drugs3. Dermatological side effects in the form of skin rashes, dryness, pruritus, pyoderma gangrenosum, alopecia, toxic epidermal necrolysis, new or exacerbation of psoriasis, induration and ulceration at the injection site can occur4. On the other hand various skin disorders such as lichen planus, necrotising vasculitis or porphyria cutanea tarda are more commonly associated with hepatitis C infection5.We as dermatologist are referred cases with cutaneous manifestations from various specialties and should be aware whether these changes are due to disease itself or its treatment. We observed 30 HCV positive and HIV negative cases with dermatological manifestations (Table- 1) on combination treatment with Ribavarin and peginterferon who came to our OPD over a period of two years for skin opinion. Out of those 30 cases, 28 patients were males and only 2 were females. They were in the age range 35 to 55 years. All of them were on a regimen of peginterferon 180mcg weekly and Ribavarin 1000mg daily for 24 weeks. All the cases were diagnosed clinically and were supported by skin biopsy where ever required. Majority of these cases belonged to genotype 3 and 4.In all the cases we took detailed history with regard to the clinical pattern of dermatological manifestation, temporal relation between drug use and onset of skin lesions, history of intake of any other drug, whether similar skin lesions were also present prior to initiation of treatment, route and frequency of drug administration as devised by Sacredots et al6.