Extrahepatic Manifestations of Hepatitis C – Part 2

This is part 2 in our series about Extrahepatic Manifestations of hepatitis C. Visit part 1.

There are a number of dermatologic problems that can be caused by hepatitis C virus. In this article I will discuss some of the more common skin problems that may occur.

Lichen Planus (LY-kin PLAN-us) appears on the skin or in the mouth, and sometimes in both places. It often has a purplish cast to the lesion and is shiny and firm. It may be very itchy. At times, on close inspection, you can see little white lines running through the bumps. While these bumps can appear anywhere on the skin, the most common places are the wrist, ankles, and lower back. In the mouth it most commonly occurs on the inside of the cheek but may also be seen on the lips and gums. It often resembles a lacey pattern. Some of the sores can be quite painful and the mouth may appear to be very red and swollen. Lichen Planus may be very uncomfortable or barely an annoyance. It is not contagious. It often resolves with no treatment. If treatment is needed it may be topical or oral steroids, oral antihistamines, PUVA light therapy or creams that also are used for eczema.

Sialadenitis is an inflammation of the salivary glands. Symptoms consist of swelling, redness, pain and tenderness. It often accompanies dry eye and sicca syndrome caused by the malfunction of the salivary gland.

Leukocytoclastic vasculitis occurs with type II mixed cryoglobulinemia. It appears as palpable or bumpy purpura (rash of purple spots caused by internal bleeding from small blood vessels) on the legs, along with ulcerations, hives, symmetric polyarthritis, muscle pain, and fatigue. This vasculitis causes itchiness, pain, or Raynauds phenomenon.

Pruritus (itching) is one of the most common and annoying symptoms, occurring in 15% of patients with hepatitis C. Nonspecific lesions were associated with pruritus in two thirds of patients. Urticaria or hives, may occur as an extrahepatic manifestation of HCV. Atopic dermatitis may occur, as well, along with keratosis which are horny growths and abnormal dryness called xerosis, that are fairly easily treated with creams.

Porphyria Cutanea Tarda (PCT) is a skin disorder caused by a deficiency of the enzyme uroporphyrinogen decarboxylase, UROD, for short. It may be genetic but is frequently an acquired disease in people who have hepatitis C. When the virus is active large amounts of porphyrins build up in the liver. This happens when iron, estrogen, alcohol, other viruses such as HIV and possibly smoking, come together and cause a deficiency of UROD. The main symptom of PCT is blistering of the skin on sun-exposed parts of the body especially after trauma to the area has occurred. It may also cause hair loss, and darkening or lightening of the skin. Diagnosis is made by a test that measures porphyrins in the blood. The main treatment in hepatitis C patients is periodic phlebotomy which removes iron from the blood. When ferritin levels and porphyrin levels fall, PCT lesions disappear. It is advisable to stay out of the sun, reduce consumption of iron-rich foods, and treatment of hepatitis C. There are medications but they may cause liver damage in patients with an already impaired liver. The prognosis is good.

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