Secondary Hyperpigmentation During Interferon Alfa Treatment for Chronic Hepatitis C Virus Infection

Abstract

Importance: Interferon alfa remains the central treatment for chronic hepatitis C virus (HCV) infection. Cases of cutaneous and mucous hyperpigmentations during interferon alfa treatment have been reported, but they are considered rare adverse effects.Objective: To study the clinical presentation and frequency of hyperpigmentation in patients receiving interferon alfa treatment for chronic HCV infection.Design: Prospective, descriptive clinical trial.Setting: Monocentric study performed in the Departments of Hepatology and Dermatology of the University Hospital of Nice, Nice, France.Participants: Consecutive patients treated with pegylated interferon alfa-2b and ribavirin for chronic HCV infection.Main Outcome Measures: Demographic data and medical history were noted. A systematic clinical and dermoscopic examination of skin, nails, and mucous membranes was performed, and skin biopsies were performed if needed.Results: Of 77 patients who were included, 16 (21%) presented with hyperpigmentation. Hyperpigmentation of the oral mucous membrane, acquired longitudinal melononychia, and hyperpigmentation of the face were each observed in 7 patients (9%). All patients with hyperpigmentation of the skin had skin type III or IV and worked outside without sun protection. The intensity of pigmentation was reported to decrease progressively when interferon treatment was discontinued. Most patients with hyperpigmentation of the oral mucosa also had melanonychia. However, patients with hyperpigmentation of the skin did not have mucosal or nail involvement, suggesting 2 distinct mechanisms.Conclusions and Relevance: Secondary hyperpigmentation during interferon alfa treatment occurs as an adverse event in 21% of patients, especially in those with dark skin types who have unprotected sun exposure. Physicians should be aware of the adverse effects of interferon treatment and advise patients in the use of sun protection, especially patients with darker skin types.JAMA Dermatol. 2013;149(6):675-677. Published online March 20, 2013. doi:10.1001/jamadermatol.2013.1989 H EPATITIS C VIRUS (HCV) infection is a global health problem, affecting 130 to 170 million individuals. Pegylated interferon alfa-2b with ribavirin has replaced interferon alfa for the treatment of chronic HCV infection. Dermatological manifestations of HCV include lichen planus, porphyria cutanea tarda, and vasculitis. Dermatological adverse effects of HCV treatments are commonly observed and are due mainly to the use of interferon alfa.1 Localized inflammatory skin reactions at the injection site, alopecia, eczema, lichenoid reactions, and worsening of psoriasis are the most frequently observed effects. Cases of cutaneous and mucous hyperpigmentation during interferon alfa treatment have been reported, but these are considered rare adverse effects.2-14 The objective of this study was to evaluate the clinical presentation and the frequency of hyperpigmentation during interferon alfa treatment. METHODS SETTING AND STUDY DESIGNA monocentric study, designed as a prospe...

An evaluation of the clinical features of measles virus infection for diagnosis in children within a limited resources setting

“…The non-infectious causes of hyperpigmentation include drug associated reactions. Some drugs could be involved here, including the antiretro viral drug, interferon alfa, non steroidal anti inflammatory drugs, anti hypertensive, antimalarial drugs, and antibiotics [47][48][49][50]. .Some forms of postinflammatory hyperpigmentation are more obvious in people with darker skin colors [17].…”

Localized pigmentation disorder after subcutaneous pegylated interferon beta-1a injection

“…It has been stated that type I IFN has a relevant cytostatic action upon melanoma cells. 4 Diffuse and localized vitiligo has been seen in both IFN-alpha-treated Hepatitis C patients 5 and, once, in an MS patient treated with Rebif 22®. 6 Similarly, facial and oral hyperpigmentation of the skin has been associated with PEG-IFN-alpha, possibly linked to the upregulated expression of melanocyte-stimulating hormone receptors.…”

Commentary on “Localized pigmentation disorder after subcutaneous pegylated interferon beta 1a injection” by Coghe et al.

“…Interferon therapies have been associated with cytostatic action upon melanoma cells 10 and vitiligo has been reported in patients with Hepatitis C treated with interferon alpha. 11 Vitiligo has also been reported in a single case of a 33-year-old female with MS treated with Rebif 22 μg s.c. three times weekly, who developed depigmented maculae on the dorsal aspects of her hands when she had been on treatment for 2 years, 22 months after the appearance of the first skin lesions, new depigmented patches occurred around the mouth and chin. 12 Unlike Coghe’s case study, these vitiligo lesions significantly improved 3 months after cessation of Rebif and remained stable on follow-up.…”