C Laboratory Tests To Monitor Response To And Adjustments In Management
Patients should be monitored for the development of symptoms such as jaundice and encephalopathy. Laboratory tests to trend include liver chemistry panel , blood counts, and coagulation panel . Aminotransferase levels may rise to levels > 1000 IU/mL before they start to trend down. The bilirubin rise and fall typically lags behind the aminotransferases by 5-7 days.
Prolongation of PT INR is an indicator of significant liver injury and requires hospitalization for close monitoring of mental status and laboratory parameters furthermore, this should prompt consideration for transfer to a tertiary care center with liver transplant capabilities if clinical status deteriorates further.
Living With Hbv And Dealing With Itchy Skin
The previous Hepbtalk blog discussed skin manifestations associated with hepatitis B and liver disease. This is a follow-up with some suggestions on dealing with rashes and pruritus skin. Unfortunately, I have experience with this.
Most people living with HBV have episodes with rashes that itch, or with an itch without the rash. Rashes can be caused by all kinds of things, but the skin truly does let us know when there is something going on with our body. We may not be able to eliminate the itch, but we can work on providing the body with a little relief, and to be sure we do not do anything to make the persistent itching worse.
First, consider the root of the problem. It is possible that your rash and itching are unrelated to the current status of your HBV infection. Unless you have serious liver disease, this might be difficult to pin down since many living with chronic HBV have compensated livers that perform all of the necessary liver functions required for life. That does not mean you arent going crazy with itchy skin, but it is important to look at other factors that may be contributing to your pruritus.
Here are some simple things you can do to help reduce the degree of pruritus:
Got any tips for reducing the itch? Feel free to comment and share your ideas with others living with HBV.
Sex And Dirty Needles
Hepatitis A can also be passed on through sex without a condom or dental dam with someone who has the virus, even if they dont have symptomsIn particular, via anal sex, fingering, rimming, fisting, or exploring the area around the anus with your fingers, mouth or tongue. Touching used condoms, sex toys and douching equipment that have been in someone elses anus can also pass the virus on.
You can protect yourself by:
- Knowing the status of your sexual partners.
- Using a new male or female condom or dental dam every time you have vaginal, anal or oral sex.
- Using a new dental dam or latex gloves for rimming and fingering or using latex gloves for fisting.
- Covering sex toys with a new condom and wash them after use.
- Avoiding sex that involves contact with faeces .
- Washing your hands after touching someones anus or handling used condoms and sex toys.
- Using a new condom for every sexual partner and having regular STI tests.
- Having the hepatitis A vaccine if youre in close contact with someone with hepatitis A or if youre in a high-risk group. This can also be provided as prophylaxis if provided within two weeks of exposure.
Sharing contaminated needles and syringes during recreational drug use can also pass hepatitis A on. Make sure you use new injecting equipment every time you inject drugs.
Pre-exposure prophylaxis does not prevent you from getting hepatitis A, nor does the contraceptive pill or other forms of contraception .
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What Is Viral Hepatitis
Viral hepatitis is inflammation of the liver due to infection with viruses from the hepatotrophic family: hepatitis A , hepatitis B , hepatitis C , hepatitis D , and hepatitis E . Many other viruses can also cause hepatitis this review will focus on the skin changes associated with infection by the known hepatotrophic viruses.
Hepatitis C virus
Rheumatoid Arthritis Can Make Your Joints Swell
With this autoimmune disorder, your body mistakenly attacks your tissue, particularly your joints. This can make your joints, particularly the smaller ones in the hands and feet, swollen and feel painful.
Over-the-counter pain relievers can help with the symptoms however, prescription medications, and oral corticosteroid can help ease the inflammation and other swelling. Other drugs known as biologic response modifiers, such as Humira , also reduce the inflammation that causes joint damage by working on the parts of the immune system that triggers it. Physical therapy, exercise, and stress reduction techniques can help joint and muscle strength and function.
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D Physical Examination Findings
The two most common physical exam findings are jaundice and hepatomegaly . Other less common findings include splenomegaly, cervical lymphadenopathy, arthritis, evanescent rash, and rarely a leukocytoclastic vasculitis. Other rare and atypical extrahepatic manifestations may include optic neuritis, transverse myelitis, Guillain-Barré syndrome, thrombocytopenia, aplastic anemia and red cell aplasia.
Easy Bleeding And Bruising
Tell your dentist or other doctors before you have any medical procedure. Treat cuts with pressure bandages and get to the doctor right away. In an emergency, youâll get platelets to replace what you lost and Vitamin K to help your blood clot. View a slideshow on the basics of bruises.
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How Do You Test For Hepatitis A
If youve been in contact with someone who has had hepatitis A, are at risk of getting hepatitis A, or if you start to have symptoms its a good idea to talk to a healthcare professional. A simple blood test will show whether you have the virus.
If you test positive, they may also do another type of blood test to check if your liver is working properly. You should also be tested for other STIs.
Its important that you tell people you live with or have close contact with, and your recent sexual partner/s so they can also get tested. Many people who have hepatitis A dont notice anything wrong, and by telling those youre in close contact with you can help to stop the virus being passed on.
What Are The Symptoms Of Hepatitis
The following are the most common symptoms for hepatitis. However, each child may experience symptoms differently and some children may experience no symptoms at all.
Symptoms of acute hepatitis may include the following:
- Flu-like symptoms
- Not feeling well all over
- Abdominal pain or discomfort
- Itchy red hives on skin
- Clay-colored stools
- Dark urine
Later symptoms include dark-colored urine and jaundice . The symptoms of hepatitis may resemble other conditions or medical problems. Always consult your child’s doctor for a diagnosis.
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Who Gets Skin Changes Related To Viral Hepatitis
Viral hepatitis due to hepatotrophic viruses can be divided into acute and chronic forms.
- Acute viral hepatitis
Skin changes are found in up to 17% of HCV-positive patients.
HDV is usually a co-infection in patients with chronic HBV accelerating progression to early liver failure.
HEV is the most common cause of acute viral hepatitis worldwide, although it is often asymptomatic or only mildly symptomatic with jaundice following a prodromal phase. It can progress to chronic infection in immunocompromised patients.
Case 4 Fatal Immunoallergic Hepatitis Due To Allopurinol
A 58 year old woman with diabetes, hypertension, gastric ulcer and gouty arthritis with hyperuricemia and mild renal insufficiency was started on allopurinol and developed fever and rash 17 days later. She had undergone resection of a parathyroid adenoma under enflurane anesthesia shortly after starting allopurinol, but she recovered uneventfully and was sent home on doxycycline in addition to her usual medications including glibenclamide, indomethacin and cimetidine. One week later she developed fever, fatigue and rash which became generalized and exfoliative. Allopurinol was stopped and she was admitted for observation. She was markedly febrile and had a generalized erythematous rash. Blood testing showed leukocyotosis and eosinophilia. Liver tests, which were previously normal, were mildly elevated on admission, but over the next few days worsened with onset of jaundice . Tests for hepatitis A and B were negative. She subsequently developed progressive prolongation of the prothrombin time followed by confusion, encephalopathy and ascites. Corticosteroids were started. She developed gram negative sepsis followed by multiorgan failure and died. Postmortem liver biopsy showed marked centrilobular necrosis, cholestasis, inflammation and small islands of regenerating hepatocytes.
|Other medications:||Glibenclamide, indomethacin, and cimetidine chronically enflurane 2 weeks before onset, doxycycline for the 6 days before onset|
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Does Hepatitis A Always Cause Symptoms
There’s a lot of variety in how people feel when they have the disease. It’s possible you might not have any symptoms. But people often feel and look sick. You might even need to go to the hospital.
Symptoms and complications are more common as you get older. Most children under age 6 with hep A don’t have any.
How Can Viral Hepatitis Be Prevented
Proper hygiene is the key to preventing the spread of many diseases, including hepatitis. Other preventive measures include:
- Vaccinations. Vaccinations are available for hepatitis A and B.
- Blood transfusion. Blood transfusions are routinely screened for hepatitis B and C to reduce the risk of infection.
- Antibody preparation. If a person has been exposed to hepatitis A or B, an antibody preparation can be administered to help protect them from contracting the disease.
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Type 1 Diabetes Can Cause Itchy Dry Skin That’s Prone To Infection
Type 1 diabetes is a chronic autoimmune disease in which the immune system attacks and destroys the insulin-producing cells in the pancreas. When you dont produce enough insulin, glucose builds up in the blood, and your body cant properly convert food into energy.
Because those with diabetes may have impaired blood flow to the feet, its important to take good care of your skin. Itchy, dry skin and bacterial and fungal infections are common. Those with type 1 diabetes are also more likely to have vitiligo. Once you have your condition under control with insulin supplementation, your skin should start to improve.
A Rare Presentation Of Hepatitis A Infection With Extrahepatic Manifestations
1Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA
2Medicine and Pediatrics, Department of Internal Medicine, University of Louisville, 529 South Jackson Street, Louisville, KY 40202, USA
Hepatitis A has a variety of associated extrahepatic manifestations that clinicians should be aware of for early diagnosis and treatment. We report a unique case of hepatitis A presenting with multiple extrahepatic manifestations not previously described in a single patient. A 34-year-old male presented with sudden onset of left sided facial pain, swelling, and skin rash, with diffuse body pains and muscle weakness, and was found to be positive for hepatitis A immunoglobulin M . He was initially started on antibiotics for concerns of bacterial parotitis but did not show any improvement. A punch biopsy of his mandibular rash and swelling was done which showed lymphohistiocytic infiltration with a few eosinophils. A trial of prednisone resulted in improvement of his symptoms. Clinicians should be aware to look for hepatitis A infection in a patient with atypical clinical picture causing a widespread systemic inflammatory response. Treatment with prednisone may result in resolution.
|Herpes simplex viruses 1 and 2||Negative|
|Rocky Mountain spotted fever||Negative|
Conflict of Interests
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Skin Signs Of Acute Viral Hepatitis
- Jaundice and associated pruritus in icteric acute viral hepatitis
- Acute urticaria is commonly associated with viral infections including HAV, HBV, and HCV
- A transientexanthem may precede typical symptoms of acute HAV infection
- Serum-sickness-like reaction presents as urticaria, fever, headache, and joint pain in 2030% of patients with acute HBV
- Henoch-Schönlein purpura reported with HAV, HBV, HEV.
Skin changes of acute viral hepatitis
Key Points About Hepatitis In Children
Hepatitis is an inflammation of the liver. It can damage and destroy liver cells.
Hepatitis in children can be caused by many things. Your child can get hepatitis by being exposed to a virus that causes it.
There are 5 main types of the hepatitis virus: A, B, C, D, and E.
The most common symptoms of hepatitis include a yellowish color to the skin and whites of the eyes and flu-like symptoms.
Some children don’t have any symptoms.
Getting vaccinated and having good hygiene can prevent hepatitis.
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Thyroid Disease Can Cause Dry Skin Hair Loss And Weight Gain
An underactive thyroid means you are producing too few thyroid hormones, in turn, your metabolism may slow down. Symptoms of hypothyroidism develop over time and may include dry skin, hair loss, weight gain, fatigue, and a sensation of being cold. Often hypothyroidism is a result of Hashimoto’s disease, when the immune system attacks the thyroid.
Hypothyroidism cant be cured, but it is generally easy to treat. You will have to take a synthetic form of the hormone as a daily pill. Periodic blood tests will help your doctor ensure you are taking the right dose. Once you have the condition under control, your symptoms will start to improve.
Skin Adverse Effects Related To Standard Of Care Treatment Of Chronic Hcv Infection
The fingerprint detector effect
The combination of pegylated interferon and ribavirin , which is the current standard of care in the management of chronic HCV infection, has significantly improved the treatment outcome. Due to the side effect profile of both drugs, a considerable number of chronic hepatitis C patients are ineligible for PEG-INF/RBV-based treatment because of medical contraindications. Moreover, vast rates of patients are unable to tolerate antiviral therapy, and account for nearly 10% of premature treatment discontinuations .
Cutaneous adverse events reported under INF plus RBV treatment of patients with chronic HCV infection
References cited in this table are partly compiled from the works of Cacoub and coworkers , Mistry and coworkers , Lübbe and coworkers , and Jadali .
Erythematous patches at the site of injection of INF
Vague eczematous patches on the extensor aspects of the limbs
Eczema involving areas exposed to friction
A coin shaped, sharply demarcated eczematous lesion ( nummular eczema
Prurigo nodularis – Bottom left corner: closeup of an excoriated nodule
Clinical grading of eczema: A, acute B, subacute C, chronic
Fixed drug eruption
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Skin Rashes And Lesions
Not everyone with hep C will develop the exact same cluster of symptoms and signs. In fact, many people with acute hepatitis C never even know they have it because they dont develop any noticeable symptoms.
But an undiagnosed case of acute hepatitis C may develop into a chronic case. And thats when you may start to notice some . Some skin problems occur because when your liver doesnt function properly, it cant effectively filter out toxins and proteins they can build up in your liver, move into your bloodstream, and start impacting your skin in several ways. Many people with chronic hep C develop a type of skin rash, either as the result of their infection or the treatment theyre taking.
A very common skin rash that affects people with hep C is urticaria, or . You might experience red or skin-toned bumps or welts that are localized in certain areas, or they might spread across wider sections of your body. Your skin may be itchy and even swollen as the result of urticaria, too.
Some people also develop lesions or where their medications are injected. Research suggests that as many as 60% of people who inject medication to treat a hepatitis C infection experience some sort of injection-site reaction. Fortunately, these reactions are typically temporary.
Dermatomyositis Causes A Skin Rash
Dermatomyositis is an inflammatory disease that causes a skin rash on the face and eyelids, as well as on the shoulders, upper chest, and back, and around the knuckles. Other symptoms include muscle weakness, shortness of breath, and trouble swallowing. It is most common in children between ages five and 15 and in adults between ages 40 and 60.
The autoimmune disorder is treated with immunosuppressants and corticosteroids. In children, the symptoms often go away completely. Adults need to be more careful as this may be a sign of another underlying disease and could develop pneumonia or lung failure, which can be fatal in some cases.
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Alopecia Areata Can Cause Large Bald Spots
If you start losing large amounts of hair creating large bald spots, it may be due to alopecia areata, a condition where the immune system attacks the hair follicles in otherwise healthy people. This disease is marked by hair loss that occurs in round patches. You may lose all the hair on your scalp or body.
Alopecia areata is an unpredictable disease, and there is no cure. Hair growth sometimes restarts on its own, or there are treatments to spur regrowth. Your dermatologist can inject your scalp with corticosteroids and prescription creams may also help. Minoxidil, which is now available over the counter, is safe for children and adults to use. While you work with your doctor on treating alopecia, you may want to try changing your hairstyle to cover the alopecia patches or temporarily using a hair piece, suggests Dr. Simzar.