Elsevier

Dermatologic Clinics

Volume 20, Issue 3, July 2002, Pages 449-458
Dermatologic Clinics

Hepatitis C and the skin

https://doi.org/10.1016/S0733-8635(02)00013-XGet rights and content

Section snippets

Etiology

Table 1 lists the major and minor risk factors for HCV infection. The two most common causes are blood or blood product transfusions (particularly before 1989) and illicit intravenous drug use. Since the development of screening techniques for HCV, intravenous drug use is now the most common risk factor accounting for two thirds of new infections [8]. Nosocomial transmission through blood product exposure has been reported in dialysis units, from hollow-bore and solid-bore needlesticks, from

Pathogenesis

The hepatic damage from HCV occurs by viral replication within liver hepatocytes. The mechanism of the extrahepatic effects is uncertain. The virus replicates within lymphoid cells potentially resulting in the extrahepatic manifestations. Another theory suggests that circulating immune complexes composed of HCVag and antibodies deposit in tissues and cause initiation of the inflammatory cascade. Other proposed mechanisms are that viral antigens induce local immune complex formation, or that

Common associations

Many cutaneous findings and diseases are associated with HCV. These may be arbitrarily divided into commonly associated, associated, and uncommonly associated conditions (Table 2). Cryoglobulinemia is commonly seen in patients with HCV. It is an immunologic disorder characterized by the presence of serum immune complexes, which precipitate at cold temperatures. These generally include rheumatoid factor, complement, HCV particles, HCV antibodies, and other immunoglobulins. There are three main

Diagnosis

There are three main laboratory evaluations used in diagnosing hepatitis C infection: (1) ELISA, (2) recombinant immunoblot assay, and (3) HCV proliferation by PCR. The ELISA test is good for general screening but has a high false-positive rate. It detects 95% of all patients with HCV infection.

The recombinant immunoblot assay test is more specific but less sensitive; if a patient has a positive recombinant immunoblot assay it is indicative of active HCV infection. If the recombinant immunoblot

Treatment

The treatment of HCV is difficult and extensive research and studies are underway to develop better therapy for the infection. Currently IFN alfa-2a, ribavirin, or amantadine are the suggested treatments. Viral serotypes are important in determining treatment response, with HCV type I being less responsive.

Hepatitis G virus

The hepatitis G virus is a newly discovered virus seen in some patients with posttransfusion hepatitis. It does not seem to be a major cause of posttransfusion hepatitis, and rarely runs a chronic course. It is seen in 10% to 25% of patients with HCV [93], [94].

Miscellaneous

Co-infection with HCV and HIV is common, occurring in 50% to 80% of people who acquired HIV through parenteral exposure. Antiretroviral with ritonavir therapy has shown to increase the risk of severe hepatotoxicity [95].

Treatment of HCV-infected patients with cyclosporin A at low doses (3 mg/kg) is safe in patients with low viral titers [96]. Corticosteroids have shown a tendency to increase viral load and should be used cautiously in patients with HCV [97].

Occult hepatitis B is commonly seen

Summary

Hepatitis C is an important and common cause of chronic hepatitis and cirrhosis. Cutaneous manifestations are often the first signs of infection. Dermatologists must be aware of these manifestations, because early diagnosis is the best treatment. HCV Ab by ELISA should be ordered in patients with LCV-urticarial vasculitis, cryoglobulinemia, lichen planus, Sjögren's syndrome, unexplained pruritus, PCT, PAN, chronic urticaria, patients starting methotrexate, unexplained pruritus, and any patient

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