PMID- 21884670 OWN - NLM STAT- MEDLINE DCOM- 20120524 LR - 20141120 IS - 1600-0641 (Electronic) IS - 0168-8278 (Linking) VI - 56 IP - 2 DP - 2012 Feb TI - Dermatological side effects of hepatitis C and its treatment: patient management in the era of direct-acting antivirals. PG - 455-63 LID - 10.1016/j.jhep.2011.08.006 [doi] AB - Dermatological adverse events (AEs) are an existing concern during hepatitis C virus (HCV) infection and peginterferon/ribavirin treatment. HCV infection leads to dermatological and muco-cutaneous manifestations including small-vessel vasculitis as part of the mixed cryoglobulinemic syndrome. Peginterferon/ribavirin treatment is associated with well-characterized dermatological AEs tending towards a uniform entity of dermatitis. New direct-acting antivirals have led to significant improvements in sustained virologic response rates, but several have led to an increase in dermatological AEs versus peginterferon/ribavirin alone. In telaprevir trials, approximately half of treated patients had rash. More than 90% of these events were Grade 1 or 2 (mild/moderate) and in the majority (92%) of cases, progression to a more severe grade did not occur. In a small number of cases (6%), rash led to telaprevir discontinuation, whereupon symptoms commonly resolved. Dermatological AEs with telaprevir-based triple therapy were generally similar to those observed with peginterferon/ribavirin (xerosis, pruritus, and eczema). A few cases were classified as severe cutaneous adverse reaction (SCAR), also referred to as serious skin reactions, a group of rare conditions that are potentially life-threatening. It is therefore important to distinguish between telaprevir-related dermatitis and SCAR. The telaprevir prescribing information does not require telaprevir discontinuation for Grade 1 or 2 (mild/moderate) rash, which can be treated using emollients/moisturizers and topical corticosteroids. For Grade 3 rash, the prescribing information mandates immediate telaprevir discontinuation, with ribavirin interruption (with or without peginterferon) within 7 days of stopping telaprevir if there is no improvement, or sooner if it worsens. In case of suspicion or confirmed diagnosis of SCAR, all study medication must be discontinued. CI - Copyright (c) 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. FAU - Cacoub, Patrice AU - Cacoub P AD - Department of Internal Medicine, Assistance Publique-Hopitaux de Paris, Groupe Hospitalier Pitie-Salpetriere, and Universite Pierre et Marie Curie, Paris, France. patrice.cacoub@psl.aphp.fr FAU - Bourliere, Marc AU - Bourliere M FAU - Lubbe, Jann AU - Lubbe J FAU - Dupin, Nicolas AU - Dupin N FAU - Buggisch, Peter AU - Buggisch P FAU - Dusheiko, Geoffrey AU - Dusheiko G FAU - Hezode, Christophe AU - Hezode C FAU - Picard, Odile AU - Picard O FAU - Pujol, Ramon AU - Pujol R FAU - Segaert, Siegfried AU - Segaert S FAU - Thio, Bing AU - Thio B FAU - Roujeau, Jean-Claude AU - Roujeau JC LA - eng PT - Journal Article PT - Review DEP - 20110830 PL - Netherlands TA - J Hepatol JT - Journal of hepatology JID - 8503886 RN - 0 (Antiviral Agents) RN - 0 (Interferon-alpha) RN - 0 (Oligopeptides) RN - 49717AWG6K (Ribavirin) RN - 655M5O3W0U (telaprevir) SB - IM MH - Antiviral Agents/*adverse effects MH - Drug Eruptions/diagnosis/*etiology/therapy MH - Hepatitis C/*complications/*drug therapy MH - Humans MH - Interferon-alpha/adverse effects MH - Oligopeptides/adverse effects MH - Ribavirin/adverse effects MH - Skin Diseases/*etiology EDAT- 2011/09/03 06:00 MHDA- 2012/05/25 06:00 CRDT- 2011/09/03 06:00 PHST- 2011/06/23 00:00 [received] PHST- 2011/07/26 00:00 [revised] PHST- 2011/08/02 00:00 [accepted] PHST- 2011/09/03 06:00 [entrez] PHST- 2011/09/03 06:00 [pubmed] PHST- 2012/05/25 06:00 [medline] AID - S0168-8278(11)00657-X [pii] AID - 10.1016/j.jhep.2011.08.006 [doi] PST - ppublish SO - J Hepatol. 2012 Feb;56(2):455-63. doi: 10.1016/j.jhep.2011.08.006. Epub 2011 Aug 30.