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Straight-erected hair in hepatitis C male patients treated with pegylated interferon and ribavirin

Gohary, Yasser M.a; El-Baky, Amin M.A.b

Journal of the Egyptian Women’s Dermatologic Society: May 2018 - Volume 15 - Issue 2 - p 111–112
doi: 10.1097/01.EWX.0000532147.57931.38
Case reports

This was a observational analysis using the data retrieved from Egypt’s National Hepatology and Tropical Medicine Research Institute. The evaluations included 500 hepatitis C virus patients on antiviral therapy (INF and ribavirin) who were collected randomly to be evaluated for their hair changes that occur during different stages of treatment from the first week of treatment till the 48th week of their antiviral therapy course. Out of 500 participants, we found hair changes in 17.3% in the form of straight, erect hair in 3% and other hair problems like diffuse hair loss in 13.4% and alopecia areata in 0.8%. Finally, we observed straight, erect hair is a new entity to be described in patients on INF and ribavirin therapy.

aDermatology Department, Faculty of Medicine, Beni-Suef University

bTropical Medicine and Hepatology National Hepatology and Tropical Medicine Research Institute, Beni Suef, Egypt

Correspondence to Yasser M. Gohary, MD, Dermatology Department, Faculty of Medicine, Beni Suef University, Mohammed Hassan Street, Beni Suef 62511, Egypt Tel: +20 100 141 6516; fax: +20 082 233 3367; e-mail: goharymy@gmail.com

Received June 22, 2017

Accepted March 16, 2018

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Introduction

Hepatitis C virus (HCV) affects about 2% of the world’s population collectively, among all nations 1. In 1992, when HCV antibody testing became widely available as a screening test, the prevalence of HCV in Egypt was reported to be 10.8% among first-time blood donors. Furthermore, HCV prevalence estimate has been reported mostly from rural communities located in the northern Nile Delta 2.

Until 2015, the standard treatment of HCV consisted of combined pegylated (Peg) interferon (either α-2a or 2b) and ribavirin (RBV), with the primary goal of achieving sustained virologic response. However, the newer treatment regimens based on sofosbuvir combination therapy, despite its successful results, are still under evaluation in some countries due to financial issues 3. Also in certain countries, modified Peg interferon and RBV are still used in the treatment of HCV with results comparable to the standard Peg-interferon (IFN) 4.

Up to 17% of the side effects of antiviral therapy are dermatological conditions 5. These conditions include prurigo nodules, purpura secondary to mixed cryoglobulinemia, porphyria cutanea tarda, lichen planus, and hair disorders. Most of these dermatological findings are treated with topical treatments 6.

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Observation

The observation was based on a large number of patients with HCV infection (500 patients), who were already on treatment with Peg-IFN and RBV therapy, from the first week of treatment to the 48th weeks in the National Hepatology and Tropical Medicine Research Institute. Hair changes were observed in 86 (17.2%) cases of the total patients. Considering hair changes, we discovered a new 15 cases with hair texture changes in the form of (hair straightening) representing 3% of the total patients. It was very obvious to see such changes in which hair became softer and erected like a spike (Fig. 1). These changes started from the 12th to the 18th week of treatment and we0re found only in men with normal noncurly hair and this condition not only affected scalp hair, but also moustache and eyebrows were affected to a lesser extent. Despite being straighter than usual, the hair was dry and accompanied by an increased rate of falling. The patients observed these findings at least 3 months after the starting of treatment despite improvement of liver enzymes. We were not able to explain this hair change. We think it will need a special trichoscopic examination and other comprehensive hair study to reach a proper explanation.

Figure 1

Figure 1

Other hair disorders were hair fall in 67 (13.4%) cases, grayish hair discoloration was observed in many cases and four (0.8%) cases of alopecia areata as one of hair changes.

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Discussion

Among the different studies discussing hair changes in patients treated with IFN/RBV, Besiss et al. 7 observed straight hair, alopecia, and graying of hair in a study.

There were no signs of increased estrogen level due to failure of its metabolism like gynaecomastia and loss of secondary sex hair, which are signs of disease severity 8, and based on the large number of the observed patients, the hair-straightening condition was more obvious in men with short hair. This may explain why this condition has not been observed in women as well as in men with long hair as the effect may become obvious with the short hair.

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Conclusion

Straight, erect hair is a very interesting observation, but we are not able to explain this hair change because it needs trichoscopic special examination and other comprehensive hair study to reach a proper explanation, which need a close observation in such patients.

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Conflicts of interest

There are no conflicts of interest.

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References

1. Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterol 2007; 13:2436–2441.
2. Abdel-Wahab MF, Kamel M, Zakaria S, Abdel-Khaliq MK, Mabrouk MA, Salama H, et al. High seroprevalence of hepatitis C infection among risk groups in Egypt. Am J Trop Med Hyg 1994; 51:563–567.
3. Sarwar S, Khan AA. Sofosbuvir based therapy in hepatitis C patients with and without cirrhosis: Is there difference? Pak J Med Sci 2017; 33:37–41.
4. Feng B, Shang J, Wu SH, Chen H, Han Y, Li YQ, et al. Efficacy and safety of pegylated interferon α-2b injection (Y shape, 40 kD) in treatment of patients with genotype 1/6 chronic hepatitis C. Zhonghua Gan Zang Bing Za Zhi 2017; 25:187–194.
5. Brett E F, Shayla F, Lisa MF. Hepatitis C virus therapy-related skin manifestations. Gastroenterol Hepatol 2010; 6:326–328.
6. Zignego AL, Ferri C, Pileri SA, Caini P, Bianchi FB. Extrahepatic manifestations of hepatitis C virus infection: a general overview and guidelines for a clinical approach. Dig Liver Dis 2007; 39:2–17.
7. Bessis D, Luong MS, Blanc P, Chapoutot C, Larrey D, Guilhou JJ, et al. Straight hair associated with interferon-alfa plus ribavirin in hepatitis C infection. Br J Dermatol 2002; 147:392–393.
8. Baker HW, Burger HG, de Kretser DM, Dulmanis A, Hudson B, O’Connor S, et al. A study of the endocrine manifestations of hepatic cirrhosis. Q J Med 1976; 45:145–178.
Keywords:

antiviral therapy; hair changes; hepatitis C virus patients; INF and ribavirin

© 2018 Egyptian Women's Dermatologic Society