Cutaneous Manifestations of Hepatitis C Treatment & Management

Updated: Apr 19, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Treatment of patients with extrahepatic dermatologic manifestations of hepatitis C virus (HCV) infection is the same as that of HCV infective state and the customary treatments of the individual conditions. Many, if not all, of the dermatologic manifestations disappear when appropriate HCV treatment or viral clearance occurs. HCV is the main cause of mixed cryoglobulinemia vasculitis, which should be treated, with new options including a combination of potent direct-actin antiviral agents and biological medications, especially rituximab. [86, 87] Malignant conditions may even disappear with effective therapy for the underlying chronic hepatitis C infection.

Currently, medical treatment of patients with HCV infection consists of interferon and ribavirin therapy. Medical therapy for patients with individual extrahepatic dermatologic manifestations of HCV infection depends on the condition.

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Surgical Care

Cryoglobulinemic vasculitis may produce nonhealing cutaneous ulcers, sometimes impetiginized and gangreneous. A combined approach with systemic and local therapy plus sharp ulcer debridement and suitable dressing and pain management may provide pivotal care. [88]

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Consultations

Involving specialists for both treatment and follow-up care often maximizes the care of individuals with extrahepatic cutaneous manifestations of hepatitis C virus (HCV). Monitoring of liver status and liver disease progression is beyond the usual purview of dermatologists and may necessitate consultation with gastroenterologists and hepatic specialists in the care of patients.

Cutaneous manifestations, serious vasculitis, lymphomas, hepatomas, and metabolic disorders may require high-level management with a team approach. Individual specialists may be an important resource in the care of patients.

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Complications

HCV may be treated with pegylated interferon-alpha/ribavirin, with dermatological adverse events uncommonly producing premature therapy discontinuation. [89]

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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.

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Long-Term Monitoring

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.

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