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Reactions 664 - 16 Aug 1997

SInterferon-α-2b

Oral lichen planus with epidermolytichyperkeratosis: case report

Oral lichen planus with epidermolytic hyperkeratosisoccurred in a 39-year-old man during treatment withinterferon-α-2b for chronic active hepatitis C infection.

Initially, the man was treated with recombinant interferon-α-2b [‘Intron A’] 3MU 3 times a week for approximately 4months, without any skin disorders. Approximately 4 monthsafter this first course, he started a second course of interferon-α-2b at a dosage of 5MU 3 times a week.

One month later, the man developed erythematous scalypatches on his scalp, chest, back, buttocks, legs and genitalia,and painful areas in his mouth. A biopsy taken from hisshoulder revealed marked psoriasiform epidermal hyperplasia,foci of epidermolytic hyperkeratosis, and parakeratosis withfocal collections of neutrophils in the stratum corneum. Abiopsy of his lip was compatible with lichen planus.

The man was treated with fluocinonide gel, dexamethasoneand tretinoin for pain in and around his oral cavity, with littleimprovement. His psoriasiform skin lesions were treated withdiflorasone ointment and resolved after 2 months even thoughinterferon-α-2b was continued. Interferon-α-2b was stoppedafter 1 year, and the man’s oral symptoms improved. Atfollow-up, the lichen planus was quiescent, but hispsoriasiform lesions were worse. [Patient outcome not stated.]

Author comment: ‘We describe oral erosive LP [lichenplanus] and psoriasiform skin lesions that appeared to beinitiated by the administration of interferon-alpha-2b therapyfor chronic active hepatitis.’ Several previous studies haveestablished an association between chronic active hepatitis andlichen planus.Schlesinger TE, et al. Oral erosive lichen planus with epidermolytic hyperkeratosisduring interferon alfa-2b therapy for chronic hepatitis C virus infection. Journal ofthe American Academy of Dermatology 36: 1023-1025, Jun 1997 -USA 800539880

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