How Hepatitis C Can Affect The Skin

Patients with chronic hepatitis C can have extrahepatic manifestations. One organ that can be affected is the skin. The most common rashes and skin conditions that are associated with hepatitis C include essential mixed cryoglobulinemia, palpable purpura/leukocytoclastic vasculitis, porphyria cutanea tarda, and B cell non-Hodgkin’s lymphoma. Less common skin conditions are Raynaud phenomenon, necrolytic acral erythema, pruritus, lichen planus, and psoriasis.¹

Mixed cryoglobulinemia

Mixed cryoglobulinemia is the most common skin manifestation in chronic hepatitis C patients. Skin manifestations include palpable purpura (21%) with or without livedo, Raynaud phenomenon (15%), pruritus (8%), urticaria (6%) and leg ulcers.² Palpable purpura are raised bruises on the body that one can feel when passing a finger over it. Raynaud phenomenon is a blue to purple discoloration of fingers and/or toes. Pruritus is itchiness on the body. Urticaria are hives. Leg ulcers are open wounds, usually found on the lower legs. Treatment with antiviral therapy will improve the skin.² In a recent study in Egypt, treatment with Sofosbuvir, Daclatasvir ± Rivabirin for 3 months improved skin symptoms in 80% of cases.³

Lichen planus

Lichen planus is a chronic inflammatory disease that affects skin, mucous membranes such as the oral cavity, genitals, and nails. It appears on the skin as itchy, pink to purple papules, usually on arms and legs but can be anywhere on the body. It affects 1% of the population overall. The cause is unknown; However, it is thought to be triggered by certain medications and viruses. Hepatitis C virus affects 2% of patients with lichen planus, and routine testing for hepatitis C is not recommended for patients who have lichen planus.¹ Lichen planus is associated with hepatitis C in Japan and the Mediterranean, and testing for hep C is recommended in these areas.⁴

Porphyria cutanea tarda

Porphyria cutanea tarda (PCT) is a rare disease that presents most commonly as blisters on the dorsal aspect of hands (front side of hands). It can also appear on any sun-exposed area of the body. It is most commonly seen in middle-aged men who had previously been diagnosed with chronic liver disease, either due to heavy alcohol use, hepatitis C, or chronic iron overload states.²

Can hep C treatment cause skin problems?

There are treatment options for hepatitis C that have been known to cause side effects affecting the skin. The use of interferon alone in treatment of HCV has been associated with the development of dermatological side effects such as injection site reactions and generalized rash (dermatitis). These are about 10% of all interferon-associated side effects. Ribavirin and interferon treatment combined has been associated with increasing the risk of a generalized rash (dermatitis) and itchiness.³

Treatment options

Hepatitis C is known to cause both liver and extrahepatic manifestations. Chronic HCV infection is now considered a systemic disease with multi-organ involvement. Over the years, there have been advancements with detection of hepatitis C as well as treatment options. Fortunately the treatment options available now can treat both the hepatitis C as well as the other organs involved, including the skin.