Widespread morbilliform eruption associated with telaprevir: use of dermatologic consultation to increase tolerability.
OBJECTIVE
Telaprevir, combined with pegylated interferon alfa and ribavirin, is an efficacious approach to treat hepatitis C virus infection. A morbilliform eruption associated with telaprevir is a common adverse effect experienced by patients. Current guidelines mandate telaprevir discontinuation in any patient with a severe, progressive, or unresponsive cutaneous eruption.


METHODS
Eight patients with a grade 3 (severe) widespread morbilliform eruption associated with telaprevir were referred to dermatology for evaluation and treatment. Each patient received a combination of antihistamines, topical corticosteroids, and thick emollient creams, rendering their eruption tolerable for the duration of treatment. No patients had evidence of a systemic or life-threatening drug reaction, developed a systemic drug eruption, or had to prematurely stop triple therapy secondary to a cutaneous eruption.


CONCLUSIONS
Patients with an uncomplicated grade 3 (severe) widespread morbilliform eruption associated with telaprevir may be able to continue triple therapy with close monitoring and dermatologic consultation. Given our findings, we propose an additional clinical classification of the telaprevir-associated eruption to better reflect the dermatologic classification of drug eruptions.
Department of Dermatology, Massachusetts General Hospital, Boston.
Lauren
L
Strazzula
Department of Gastroenterology, Massachusetts General Hospital, Boston.
Daniel S
DS
Pratt
Department of Gastroenterology, Massachusetts General Hospital, Boston.
Janet
J
Zardas
Department of Gastroenterology, Massachusetts General Hospital, Boston.
Raymond T
RT
Chung
Department of Gastroenterology, Massachusetts General Hospital, Boston.
Michael
M
Thiim
Department of Dermatology, Massachusetts General Hospital, Boston.
Daniela
D
Kroshinsky
D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects*; D003880:Dermatology; D003875:Drug Eruptions / Q000145:classification / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000009:adverse effects*; D012017:Referral and Consultation
D000998:Antiviral Agents; D009842:Oligopeptides; C486464:telaprevir