eMedicine Specialties > Dermatology > Viral Infections

Cutaneous Manifestations of Hepatitis C: Follow-up

Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Arthur P Birnkrant, MD, Clinical Instructor, Department of Dermatology, University of Medicine and Dentistry of New Jersey
Contributor Information and Disclosures

Updated: Sep 8, 2009

Follow-up

Further Outpatient Care

  • Treatment of various primary, secondary, tertiary, hepatitis C virus (HCV)–related, and associated conditions is for the individual conditions. The continued successful care of patients requires attention to the underlying HCV infection of the hepatocytes and the extracutaneous disorder of symptoms.

Deterrence/Prevention

  • Deterrence and prevention of the cutaneous manifestations of hepatitis C virus (HCV) are the same as in acute HCV. The primary concerns are to avoid inoculation of the virus into healthy persons through contaminated blood and organs, to prevent needlestick in at-risk groups (eg, health care workers), and to avoid high-risk behavior (eg, sharing cocaine-snorting straws and contaminated needles in pursuit of addictive drugs); all of these measures markedly reduce the likelihood of HCV infection.

Prognosis

  • The prognosis of patients with dermatologic manifestations of hepatitis C virus (HCV) infection rests on the success of therapy for the underlying HCV. At this time, many successes show that eradication of HCV infection is the key factor in the prognosis. The importance of discovering HCV infection magnifies as new therapies develop.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to diagnose an underlying condition and inappropriate or inadequate discovery and planning or treatment perpetuate hepatitis C virus (HCV) and create suboptimal care situations. The clinician  must decide how to proceed in situations in which underlying HCV is suggested by an existing history of risk factors. He/she must be comfortable with the level of skill in identifying HCV infection and must be aware of the success and failure of tests available to be willing to proceed with diagnosis. Likewise, individual cutaneous manifestations of HCV may be uncommon and unfamiliar. The severity of the disease makes early diagnosis and exacting care more critical.
  • Failure of diagnosis leaves the clinician at risk if proper care to diagnose or seek further help was not taken. Reading about HCV creates awareness of the possibility of HCV in at-risk patients, especially in patients who present with cutaneous or other extrahepatic manifestations consistent with HCV infection. Accurate and timely diagnosis of HCV is more critical as better drugs become available for the treatment of HCV. At-risk individuals with markers of HCV disease must be properly diagnosed.

Special Concerns

  • Transmission from mother to child in utero relates to HIV/HBV co-infection and density of viral infection with hepatitis C virus (HCV).
    • While particle density of HCV infection of approximately 100 particles per milliliter produced no vertical transmission to the baby, 1 million HCV particles per milliliter resulted in a transmission rate of 36%.70
    • Overall, transmission to babies was 6% in mothers who were HCV-antibody positive and 10% in mothers who were HCV-RNA positive.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Michael Birnkrant, BS, to the development and writing of this article.



More on Cutaneous Manifestations of Hepatitis C

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Differential Diagnoses & Workup: Cutaneous Manifestations of Hepatitis C
Treatment & Medication: Cutaneous Manifestations of Hepatitis C
Follow-up: Cutaneous Manifestations of Hepatitis C
Multimedia: Cutaneous Manifestations of Hepatitis C
References
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Further Reading

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Keywords

hepatitis C virus, hepatitis C virus skin disease, HCV skin disease, lichen planus, acral necrolytic erythema, sialadenitis, chronic hepatitis C, cryoglobulinemia, leukocytoclastic vasculitis, Mooren corneal ulcer, antiphospholipid syndrome, Behcet's disease, Behcet disease, canities, Hyde's prurigo nodularis, Hyde prurigo nodularis, thyroiditis, thrombocytopenia, vitiligo, polyarteritis nodosa, pruritus, urticaria, hepatic failure, thyroid failure, porphyria cutanea tarda, non-Hodgkin lymphoma, verrucous squamous cell carcinoma of the tongue, mucosa-associated lymphoid tumor syndrome, MALT syndrome, hepatoma, lichen planus, erythema dyschromicum perstans, disseminated superficial actinic porokeratosis, hepatocellular cancer, granuloma annulare, symmetric polyarthritis, livido reticularis, arteriovenous hemangiomas, Gougerot-Blum disease, capillaritis of the lower legs, Schamberg's disease, Schamberg disease, progressive pigmented purpura

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Arthur P Birnkrant, MD, Clinical Instructor, Department of Dermatology, University of Medicine and Dentistry of New Jersey
Arthur P Birnkrant, MD is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery
Disclosure: Nothing to disclose.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Palomar Medical Technologies Stock None; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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