| Evaluation of Dermatological Side Effects During Interferon Alfa Therapy for Chronic Hepatitis C and Hepatitis B
Interferon alfa therapy may occasionally cause immune-mediated phenomena. This prospective case-control study in a tertiary referral center in Greece was conducted to investigate the incidence of the development of immune-mediated dermatological diseases during interferon alfa therapy in patients with chronic hepatitis C and hepatitis B.
One hundred and twenty consecutive patients with chronic viral hepatitis (67 with hepatitis B, 45 with hepatitis C, six with both hepatitis viruses, and two with delta hepatitis) were evaluated during a course of interferon alfa therapy. In addition, 120 consecutive patients with chronic liver diseases (disease control group), who had never received interferon alfa therapy, were evaluated during the period of the study (at least for 12 months).
Recombinant interferon alfa at a dose of 4.5 or 5 million units subcutaneously (s.c.) three times per week for 6 to 12 months was administered to patients with hepatitis B. The patients with chronic hepatitis C were treated with 3 million units s.c. three times per week for 12 to 18 months.
The patients with chronic hepatitis B and C infections received 4.5 million units for 6 months, and then 3 million units for an additional 6 to 12 months.
The patients with chronic delta hepatitis received 5 million units for 1 year or more.
The main outcome measures were to assess prospectively the incidence of these dermatological disorders during alpha-interferon therapy and to estimate if there is any relationship between their development and the clinical, laboratory or other characteristics of the patients with chronic hepatitis.
Results
Three to 6 months after the initiation of interferon alfa three patients with chronic viral hepatitis (two with hepatitis C and one with hepatitis B) developed lichen planus, whereas one patient with hepatitis C developed relapsing aphthous stomatitis.
The development of these disorders was significantly associated only with the presence of antinuclear antibodies before the initiation of interferon alfa. None of the patients from the disease control group had such a manifestation during the follow-up.
Lichen planus resolved after the end of therapy in all of them. In contrast, therapy was discontinued in the patient who developed aphthous stomatitis, due to the painful lesions.
Conclusions
This study demonstrated that alpha-interferon may rarely (3.3%) induce immune-mediated dermatological disorders, especially lichen planus.
In conclusion, the authors write, 揟he development of these disorders may reflect a subclinical or covert autoimmune background of patients, as suggested by the presence, although in low titres, of antinuclear antibodies. However, when lichen planus developed, it was mild, did not require the discontinuation of therapy and resolved after interferon alfa administration had ceased.
Department of Internal Medicine, Medical School, University of Ioannina, Greece.
04/13/05
Reference
G N Dalekos and others. A prospective evaluation of dermatological side-effects during alpha-interferon therapy for chronic viral hepatitis. European Journal of Gastroenterology and Hepatology 11: 933-939. November 10, 1998.
| 
发表于 2005-4-21 01:14
