الفهرس 
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Abstract
HCV infection is found worldwide. Countries with high rates of chronic HCV infection are Egypt (15%) as there was more than 500,000 new HCV infection per year were estimated. HCV association with extrahepatic manifestations can occur in one third of patients with chronic infection and is generally seen in the late stages of the disease. Combination therapy of interferon alfa (IFN α) plus ribavirin is currently considered the treatment of choice of chronic HCV because it has demonstrated higher sustained viral response. The increasing use of this combination has brought forward a number of new cutaneous manifestations. A number of skin disorders are autoimmune in nature and immunomodulatory activity of IFN may exacerbate these dermatologic disorders. In addition, dermatologic disorders may require prolonged immunosuppressive therapy, which can increase HCV viremia and worsen liver disease.
The objective of this work was to evaluate the cutaneous manifestations of chronic hepatitis C patients receiving interferon α plus ribavirin therapy. This study included 200 HCV-positive patients receiving interferon α plus ribavirin all of them attended the gastroenterology and hepatology hospital in Sohag governate . This study was conducted between February 2011 to May 2012. 125 (62.5%) of the studied patients had cutaneous side effect with the combined therapy (INF α plus ribavirin), 113 patients of them showed cutaneous side effects only with treatment. But 12 patients of them showed cutaneous side effects with treatment & exacerbation of old skin diseases with HCV. 75 (37.5%) had not any cutaneous side effects with the duration of treatment, 40 patients of them had past history of skin diseases with HCV only(36 patients showed exacerbation with therapy, 3 patients showed no effect with therapy and only one showed remission) and 35 patients were completely free from any skin diseases with duration of treatment and had not past history of skin diseases with HCV.
The current study reported, 117 (58.5%) cases of studied patients between 40-60 years. (72.5%) of the studied patients were males with sex ratio 3:1. 143 (71.5%) of the studied patients had HCV less than 5 years. 107 (53.5%) of the studied patients were manual work. 178 (89%) of the studied patients were from rural ares. 164 (82%) of the studied patients were married. 120 (60%) of the studied patients were not smoker. 137 (68.5%) of the studied patients had negative family history of HCV.
In this work, of 200 HCV- positive patients receiving the combination therapy( INF α & ribavirin), 52 (26%) of cases had past history of skin diseases (which already present before starting combination therapy) . Psoriasis was the most common dermatological disease (5.5%).This was followed by eczema (4%). Lichen planus was present in (3.5%).
In the present study, of 200 HCV- positive patients receiving the combination therapy ( INF α & ribavirin) for 48 weeks, 125 patients (62.5%) have developed one or more skin diseases during combined therapy ( INF α & ribavirin). Generalized pruritus was the most common dermatological side effect (10.5%). This was followed by localized pruritus was seen in (8%). Irritation at site of injection which was seen in (7%). Alopecia was seen in (6.5%).
Other cutaneous manifestation observed with combination therapy, in order of frequency, were Melasma, Vitiligo, Oral lichen planus, seborric dermatitis, urticaria, hair falling, apthous ulcer, eczema, photosensitivity, lichenoid eruption, herpes zoster, pityriasis versicolor, psoriasiform eruption and lichen planus.
In the present study, all 200 patient had extracutaneous manifestation. These patients presented with one or more extracutaneous manifestation. Loss of weight was the most common extracutaneous manifestation (57.5%), with mean 0f (11 Kg). This was followed by flu like symptoms (44.5%), malaise was seen in (42.5%). depression was seen in (30.5%).
Other extracutaneous manifestation observed were loss of appetite, anemia, burning mouth, psychosis, altered taste sensation, and jaundice.
In conclusion, 125 (62.5%) of the studied patients showed new cutaneous lesions with the combined therapy (INF α plus ribavirin) during 12 months of the treatment, 113 patients of them showed new cutaneous side effects only with treatment, and 12 patients of them showed new cutaneous side effects with treatment & past history of old skin diseases with HCV. Generalized pruritus was the most common dermatological side effect. 52 (26%) of cases had past history of skin diseases (which already present before starting combination therapy) . Psoriasis was the most common dermatological disease . 33 ( 63.46%) patients of them had HCV less than 5 years. So there was no statistically significant relation between past history of skin diseases and duration of hepatitis C virus.