Tongue and Skin Hyperpigmentation During PEG-Interferon-alpha/Ribavirin Therapy in Dark-Skinned Non-Caucasian Patients with Chronic Hepatitis C

Abstract

Various skin disorders may occur during antiviral therapy with interferon (IFN) and ribavirin (RBV) for chronic hepatitis C. This article describes to our knowledge the first report of lingual hyperpigmentation during pegylated (PEG)-IFN/RBV combination therapy in five dark-skinned hepatitis C virus (HCV) patients. Lingual pigmentation during antiviral therapy was not associated with age, gender, HCV genotype, doses of RBV, or duration of the treatment or treatment outcome. Since IFN increases the expression of alpha-melanocyte-stimulating hormone (MSH) surface receptors, the use of PEG-IFN having a longer plasma half-life may even increase incidence for such cutaneous side effects particularly in dark-skinned HCV patients.

Tongue hyperpigmentation during hepatitis C treatment: Figure 1:

“…In one series, it was observed in 5 of 171 dark-skinned patients versus none in 149 white patients. 1 However, instances in white patients have also been reported. 2 This adverse effect usually develops within the first few months of treatment, and improves or disappears slowly after the end of therapy.…”

“…1 Histologic examination shows increased amounts of melanin in the basal layer of the epithelium. 2 Upregulation of melanocyte-stimulating hormone receptors by interferon-α is suspected, which increases tyrosinase activity in melanocytes and tyrosine, the main precursor of melanin.…”

Cytokines Induced Skin Adverse Reactions

“…• Polyethylene glycol (PEG)-containing product, seems to induce more frequent adverse reactions and a large number of side-effect cases related to combination therapy with ribavirin have been reported [65][66][67][68][69].…”

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

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] The only reported series included 5 cases of hyperpigmentation in 171 treated patients. 10 Our results confirm that interferon alfa can induce hyperpigmentation of the skin, nails, and mucosa at a significantly higher rate than in the earlier series (21% vs 2.9%). 10 The difference can be explained by the fact that we performed a systematic dermatological examination whereas the previously reported incidence reflected only the adverse effects reported during 2 clinical trials studying the efficacy of pegylated interferon with ribavirin.…”