Tinea manus during interferon-a therapy for chronic hepatitis C

European Journal of Dermatology. Volume 10, Number 7, 565-6, October - November 2000, Votre diagnostic !

Author(s) : T. Koga, A. Shimizu, Y. Kubota, J. Nakayama, Department of Dermatology, School of Medicine, Fukuoka University, Japan..

Summary : A 44-year-old woman was admitted to the Department of Internal Medicine of Fukuoka University Hospital for IFN-a administration to treat chronic hepatitis C. In her past medical history, she had experienced tinea pedis 5 years before starting IFN-a therapy. Asymptomatic scaly lesions on her right fingers appeared 6 days after the intramuscular administration of 10 million units of recombinant IFN-a2b five times per week was initiated. She had no special risk factors for the present lesions. A clinical examination revealed slight scaling plaques on the volar aspect of her first and second finger of the right hand (Fig. 1). No palmar or plantar involvement was observed. There was no relapse of the tinea pedis lesions.

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ARTICLE

Tinea manus was proven by KOH-preparations and a positive culture (Trichophyton rubrum). The skin lesion responded gradually and effectively to treatment with topical anti-fungal drugs, and disappeared within 14 days despite continuing the IFN-alpha therapy.

Comments

IFN-alpha was originally described as a protein capable of inducing antiviral activity in cells, and it has since been used to treat chronic hepatitis C. A variety of side effects have been associated with its administration. Such side effects as chills, fever, arthralgia and fatigue seem to be inevitable during therapy. Because IFN-alpha is a potent immune modulator that influences both cellular proliferation and differentiation, it is plausible that its use could lead to skin changes. The reported skin changes associated with IFN-alpha administration have included either an aggravation of or an induction of psoriasis and lichen planus [1, 2]. In this report, we presented a patient who developed tinea manus related to the administration of IFN-alpha.

Dermatophytosis has only rarely been reported to be associated with IFN-alpha therapy. To our knowledge there are at least two Japanese reports of such an association [3, 4]. A worsening of tinea pedis and manus 5 days after IFN-beta therapy was reported [3], and three cases with the onset of tinea unguium during IFN-alpha therapy were described [4]. Our case is consistent with these reports, which therefore indicates the possibility that IFN therapy may play an aggravating role in dermatophytosis. Concomitant dermatophytosis still is rather weak proof for a pathogenic link to IFN-alpha therapy. However, it should be noted that either an aggravation of, or an induction of dermatophytosis may occur as one of the adverse side effects of IFN-alpha therapy. Furthermore, these observations suggest the possibility that IFN-alpha may also participate in the pathophysiology of dermatophytosis.

The exact mechanism through which this occurs is still unclear. Some clinical manifestations of dermatophytosis may be attributed to a delayed-type hypersensitivity (DTH) response against dermatophyte antigen. IFN-gamma-mediating DTH (Th1 cytokine-mediated process) is responsible for producing the cutaneous manifestation of dermatophytosis [5]. IFN-alpha appears to influence the cytokine cascade towards an increased Th1 expression [6]. Since the clinical signs of dermatophytosis are considered, in part, to consist of an immune response of Th1 cytokine, IFN-alpha therapy may therefore influence the cutaneous manifestation of dermatophytosis.

Article accepted on 18/07/00

REFERENCES

1. Funk J, Langeland T, Schrumpf E, Hanssen LE. Psoriasis induced by interferon-alpha. Br J Dermatol 1991; 125: 463-5.

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3. Dohmen K, Shirahama M, Onohara S, Miyamoto Y, Ohta Y, Takeshita T, Irie K. Worsening of tinea pedis and manus during interferon therapy for chroni hepatitis C a case report. Naikasenmonikaishi 1998; 10: 74-7 (in Japanese).

4. Fukuda A, Teranuma K, Yoshimoto S, Kobayashi H, Osawa N. Three cases with nail damage due to tinea unguium occurring during interferon therapy for chronic hepatitis C. Acta Hepatologica Japonica 1996; 37: 502-6 (in Japanese).

5. Koga T, Ishizaki H, Matsumoto T, Hori Y. In vitro release of interferon-gamma by peripheral blood mononuclear cells of patients with dermatophytosis in response to stimulation with trichophytin. Br J Dermatol 1993; 128: 703-4.

6. Brinkmann V, Geiger T, Alkan S, Heusser CH. Interferon-alpha increases the frequency of interferon-g-producing human CD4 T cells. J Exp Med 1993; 178: 1655-63.