| Abstract: |
There are many cutaneous side effects associated with the use of combination pegylated interferon alfa-2b (PEG-IFN) and ribavirin (RBV) therapy, which are used to treat hepatitis C. The cutaneous side effects commonly include local reactions at the injection site and development of worsening lichen planus, psoriasis, and vitiligo. This article describes a case report of alopecia universalis (AU) following hepatitis C treatment with PEG-IFN and RBV. The case patient was a 45-year-old Caucasian woman with chronic hepatitis C (CHC) whose past medical history was significant only for hypothyroidism and whose physical examination was unremarkable before starting treatment with PEG-IFN/RBV. After 12 weeks of treatment, her hepatitis C virus RNA level was undetectable and her treatment course was rather typical, although she developed mild anemia. At 45 weeks, the patient reported a significant amount of hair loss from her scalp, which progressed to include her eyebrows and hair on her upper and lower extremities, followed by hair loss in axillary and pubic areas at the end of treatment at 48 weeks. A dermatologist who evaluated the patient diagnosed her condition as AU, confirmed by skin biopsy that showed multiple hair bulbs surrounded and focally infiltrated by a chronic inflammatory cell reaction. Even 1 year after therapy discontinuation, there was no hair regrowth in this patient. The authors briefly discuss the pathogenesis and etiology of AU, noting that their patient started to have hair regrowth after 1 year, without specific treatment for her AU. They conclude that, considering the benign and reversible nature of AU associated with PEG-IFN/RBV treatment, patients should not be discouraged to initiate or complete their treatment for CHC. Appended to the article is a commentary written by Taliani and Biliotti; they echo the conclusions reached by the reporting authors. 32 references. |