clobetasol and Hepatitis-C--Chronic

Topics: Clobetasol; Dermatologic Agents; Diagnosis, Differential; Erythema; Hepatitis C, Chronic; Humans; Male; Middle Aged; Necrosis; Skin; Skin Diseases; Trace Elements; Treatment Outcome; Zinc

A 50-year-old woman presented with diffuse, intensely pruritic pink-red papules on her trunk and extremities three weeks after starting combination therapy with ribavirin, telaprevir, and interferon. She also had cervical lymphadenopathy, fever, eosinophilia, and transaminitis consistent with a severe drug reaction to telaprevir. She was started on high potency topical steroids under inpatient observation and recovered within two weeks. Severe cutaneous eruptions secondary to telaprevir have resulted in black-box warnings for potentially fatal skin reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) and Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN). Because these reactions carry acute mortality rates of 10%, prompt detection and treatment with steroids are important. As such, physicians should be aware of these potentially lethal side effects.

Topics: Anti-Inflammatory Agents; Clobetasol; Drug Hypersensitivity Syndrome; Drug Therapy, Combination; Female; Hepatitis C, Chronic; Humans; Middle Aged; Oligopeptides; Ribavirin; Stevens-Johnson Syndrome

Topics: Clobetasol; Diagnosis, Differential; Genital Diseases, Male; Glucocorticoids; Hepatitis C, Chronic; Humans; Lichen Planus; Male

Chronic hepatitis C virus (HCV) infection is associated with necrolytic acral erythema (NAE). However, the prevalence of NAE among patients with HCV is unknown, and the clinical and histologic features have not been well defined.. We sought to determine the prevalence, overall clinical features, and cutaneous histopathological characteristics of patients with NAE.. A cross-sectional study was performed among patients with chronic HCV infection cared for at 3 Philadelphia hospitals. Patients completed a questionnaire and underwent a dermatologic examination. All undiagnosed skin lesions with clinical features of NAE as described in the literature underwent skin biopsy.. Among 300 patients with chronic HCV infection (median age 55 years; 73% male; 70% HCV genotype 1), 5 of them (prevalence 1.7%; 95% confidence interval 0.5%-3.8%) had skin lesions consistent with NAE clinically, which were analyzed and confirmed with skin biopsy specimen. All 5 skin biopsy specimens demonstrated variable psoriasiform hyperplasia, mild papillomatosis, parakeratosis, and necrotic keratinocytes in the superficial epidermis. All 5 patients were older than 40 years, were African American men, were infected with HCV genotype 1, and had a high viral load (>200,000 IU/mL).. Previous descriptions of NAE were used to guide the evaluation and need for a biopsy; however, other unknown clinical characteristics of the disease may exist. The senior author was the sole interpreter of the biopsy specimens. Only 300 of the 2500 eligible patients enrolled in the study.. The prevalence of NAE among patients with chronic HCV in this sample was very low. Further research is needed to determine the origin and appropriate therapies of NAE.

Topics: Clobetasol; Cross-Sectional Studies; Erythema; Female; Glucocorticoids; Hepatitis C, Chronic; Humans; Male; Middle Aged; Prevalence; Prospective Studies; PUVA Therapy

Topics: Clobetasol; Female; Hepatitis C, Chronic; Humans; Lichen Planus; Lichen Planus, Oral; Middle Aged