Monday, January 30, 2023

Skin Manifestations Of Hepatitis C

Skin Rashes And Lesions

Hepatitis C Symptoms

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 skin symptoms. 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 hives. 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 sores 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.

Ask Your Doctor About Skin Symptoms

First, consider scheduling an appointment with your doctor or dermatologist. Not every skin rash is indicative of a hepatitis C infection or of liver damage. Your physician will be able to identify your rash and either explain why it is occurring or order tests to verify or rule out other illnesses, including hepatitis C. If you are diagnosed with hepatitis C, your physician will be able to provide you with both the test results and the information so you can begin to understand what happens next to rid your body of the virus. Together, you and your doctor will plan a course of action that fits with your insurance, your budget, and your individual medical needs.

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Clinical Syndromes Of Hcv

The most common HCV-related renal disease is membranoproliferative glomerulonephritis associated with type II mixed cryoglobulinemia. Most HCV-related membranoproliferative glomerulonephritis occurs as a result of mixed cryoglobulinemia . Conversely, renal disease occurs in only 30% of persons with cryoglobulinemia. Most individuals with HCV-related membranoproliferative glomerulonephritis develop hypertension, which is often severe and difficult to control. Approximately 5% of persons with HCV-related renal disease will develop glomerular renal disease that manifests as oliguric acute renal failure. Laboratory findings of cryoglobulinemia-associated renal disease include proteinuria, microscopic hematuria , and low serum concentrations of complement components . In addition to membranoproliferative glomerulonephritis, other types of HCV-related renal disease also exist, including IgA nephropathy, postinfectious glomerulonephritis, membranous nephropathy, thrombotic microangiopathies, focal and segmental glomerulosclerosis, fibrillary or immunotactoid glomerulopathy, and glomerulonephritis associated with polyarteritis nodosa. These disorders, however, are all less common among persons with chronic HCV than HCV-related membranoproliferative glomerulonephritis.

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How Is Purpura Diagnosed

Purpura isnt a diagnosis. Its a sign of something else. Once your healthcare provider determines the discolored skin spots are purpura, they must determine whats causing it.

Your healthcare provider will begin with an examination of your skin. Theyll discuss your medical history and any drugs or medications youre taking. Theyll take note of the size and color of the purpura and ask you when they first appeared.

Your healthcare provider may recommend tests such as a complete blood count or a skin biopsy to determine the cause of the purpura.

Determining if the purpura is related to a blood clotting disorder or platelet issue is the first step in diagnosing the condition causing purpura. A blood test will reveal a low platelet level. If platelet levels are OK, a skin biopsy may be the next step.

Skin Adverse Effects Related To Standard Of Care Treatment Of Chronic Hcv Infection

Hepatitis C  10 Frequent Symptoms

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 .

Figure 17.

Erythematous patches at the site of injection of INF

Figure 18.

Vague eczematous patches on the extensor aspects of the limbs

Figure 19.

Eczema involving areas exposed to friction

Figure 20.

A coin shaped, sharply demarcated eczematous lesion ( nummular eczema

Prurigo nodularis â Bottom left corner: closeup of an excoriated nodule

Figure 23.

Clinical grading of eczema: A, acute B, subacute C, chronic

Figure 24.

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Relationship Of Hcv And Lymphomas

Chronic HCV infection has been associated with an increased risk of developing B-cell non-Hodgkin lymphoma as well as primary hepatic lymphoma. There is a particularly strong association of HCV with B-cell non-Hodgkin lymphoma, with epidemiologic studies involving persons with chronic HCV showing a two-fold increased risk of developing non-Hodgkin lymphoma this relative risk increases to approximately 35-fold in persons with symptomatic HCV-associated mixed cryoglobulinemia. Roughly 5 to 10% of individuals with HCV-associated mixed cryoglobulinemia will develop non-Hodgkin lymphoma. Among persons with B-cell non-Hodgkin lymphoma, the HCV prevalence is approximately 15%. The increased risk of developing non-Hodgkin lymphoma is reduced, but not eliminated after eradication of HCV. One study examined 3,209 persons with HCV and the overall annual incidence of lymphoma was significantly lower in HCV-treated persons who achieved an SVR when compared with those who had persistent HCV infection .

Easy Bruising And Bleeding

In the advanced stages of hepatitis C, you may see easy bruising and excessive bleeding for no apparent reason. Abnormal bruising is believed to be the result of the liver slowing the production of platelets, or proteins needed to clot blood.

In more serious cases, there can be excessive bleeding of the nose or gums, or blood in the urine.

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Pattern Of Skin Manifestations In Chronic Hepatitis C Virus Patients Before And After Direct Acting Anti Viral Drugs

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
Verified May 2017 by Hagar Maher, Assiut University. Recruitment status was: Not yet recruitingFirst Posted : May 30, 2017Last Update Posted : May 30, 2017
  • Hepatitis C is an infectious disease caused by the hepatitis C virus that primarily affects the liver. It is one of the main causes of chronic liver diseases worldwide .
  • According to World Health Organization , 2011 , Egypt has particularly high rates of Hepatitis C .
  • Hepatitis C virus is known to induce both hepatic and extra-hepatic manifestations. About 17% of HCV patients present with at least one skin manifestation, which can be directly or indirectly induced by chronic HCV infection .
Condition or disease
Hepatitis C, Chronic

Porphyria Cutanea Tarda Overview

Lichen Planus (âPurple Skin Lesionsâ?) | Causes, Signs & Symptoms, Diagnosis, Treatment

Porphyria is a group of disorders that result from abnormalities in enzymatic activity during heme and porphyrin synthesis. Although porphyria cutanea tarda is the most common form of these disorders, it is rare, affecting an estimated 1 in 25,000 people in the United States.1 PCT results when there is a deficiency of the enzyme uroporphyrinogen decarboxylase , the fifth enzyme in the biosynthesis of heme, resulting in excess build-up of porphyrins in the liver and skin.6

PCT can be subdivided into 2 types: sporadic , making up 80% of cases, and familial , making up 20% of cases. Those with familial PCT have a mutation in their UROD gene, whereas those with sporadic PCT do not. Regardless of type, PCT usually remains latent until an activating factor is present, such as HCV infection. Worldwide studies have shown the prevalence of sporadic PCT among patients with HCV to range from > 70% to about 50%.1 The mechanism through which HCV infection leads to PCT remains unknown.1,6

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Skin Signs Of Liver Cancer

Liver cancer can also cause different types of rashes, particularly if HCV is the underlying cause. These not only include previously mentioned conditions like dermatomyositis but also:

  • Acanthosis nigricans: This is the darkening and thickening of the skin commonly seen in people with hepatocellular carcinoma. It is often seen in skin folds of the groin, armpits, and neck.
  • Acanthosis palmaris: Also known as “tripe hands,” this is the thickening of the skin of the palms accompanied by an abnormal velvety skin texture.
  • LeserâTrélat sign: This is the abrupt outbreak of raised, brownish lesions called seborrheic keratoses, most commonly on the back but sometimes on the legs, arms, face, and neck. The sudden appearance of these lesions is characteristic of different cancers.

Can Hepatitis Be Treated

Today, hepatitis management is applicable through different medications and the blood product intravenous immunoglobulin for temporary immunity. However, specific antiviral effects like a nucleotide polymerase inhibitor work in slowing down the virus. Although there are famous names like Ledipasvir with sofosbuvir and Pegylated interferon and ribavirin, some of these medications arent prescribed anymore. However, modern medical technology is changing chronic liver diseases using oral tablets taken every day for at least two to six months.

Ask your pharmacist or your current liver doctor to know if certain drugs arent verified with FDA or harmful to your health status.

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Hepatitis C: How Does It Spread

It spreads through infected blood. In the U.S., sharing needles or other items used to inject drugs is the most common cause of infection. Getting a tattoo or body piercing with an infected needle is another means of exposure. A mother may pass the virus to their child at birth. In rare cases, unprotected sex spreads hepatitis C, but the risk appears small. Having multiple sex partners, HIV, or rough sex seems to raise risk for spreading hepatitis C.

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What Causes Skin Changes With Viral Hepatitis

Hepatitis Rash

Skin changes in acute viral hepatitis can be nonspecific such as the itch secondary to jaundice. Chronic viral hepatitis can cause progressive liver failure and skin changes due to cirrhosis or hepatocellular carcinoma.

Skin changes seen with viral hepatitis can be due to:

  • Direct viral infection of skin cells with viral particles detected in keratinocytes and lymphocytes
  • Autoimmune origin as HCV is lymphotropic promoting B-cell proliferation and circulating autoantibodies can be detected
  • Effects on the liver seen in acute viral hepatitis and subsequent chronic liver disease.

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What Do Hepatitis Symptoms Look Like In Children

The C.D.C. issued an alert after clusters of severe hepatitis cases popped up among children around the globe. What signs should parents watch out for?

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The Centers for Disease Control and Prevention issued an alert on Thursday to physicians nationwide notifying them of a cluster of severe and unexplained hepatitis cases in otherwise healthy young children.

Between October 2021 and February 2022, nine children between the ages of 1 and 6 in Alabama were admitted to the hospital with acute hepatitis two required liver transplants.

Similar cases have also popped up in North Carolina, as well as in Europe. The U.K. Health Security Agency has reported more than 100 cases of sudden-onset hepatitis in children under 10 since January 2022, 10 of whom required liver transplants.

Heres what we know about these hepatitis cases, and what symptoms parents should watch for.

Lp Presentation And Diagnosis

Classic LP typically presents as pruritic, polygonal, violaceous flat-topped papules or plaques on the flexural surfaces of the wrists and forearm and/or extensor surface of the hands, ankles, and shins.1,4,5 Although LP can affect any part of the body, the face is rarely involved.5 LP lesions typically have a symmetric distribution. Papules often appear dry and shiny, with branny scales that form fine, whitish streaks .5 Depending on lesion location, patients may report pain, itching, hair loss, scalp discoloration, and nail damage or loss.

LP is diagnosed on the basis of history and physical examination, including visual inspection of the entire cutaneous surface and oral cavity. A punch or shave biopsy extending to the middermis can help make a definitive diagnosis.

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Skin Signs Of Cirrhosis

Cirrhosis not only affects the liver but also the blood and circulatory system. Abnormal blood clotting accompanied by bleeding and/or dilation of blood vessels near the surface of the skin can cause symptoms like:

  • Spider angiomas: Also known as spider veins or spider nevus, these are thin reddish or purplish lines on the skin’s surface that look like a spider’s web.
  • Petechiae: These are purplish dots on the skin caused by burst and bleeding capillaries, most often on the lower legs.
  • Purpura: Also known as skin hemorrhages or blood spots, these purple-colored spots are larger than petechiae, mainly on the lower legs and ankles.

Related Skin Problems With Hepatitis C Infection

Hepatitis, Causes, Signs and Symptoms, Diagnosis and Treatment.

Some skin conditions share a possible association with chronic hepatitis C. For reasons not entirely clear, the risk of these is higher in people with hepatitis C than in the general population.

  • Psoriasis: This autoimmune condition causes dry, raised, inflamed patches of skin covered with silvery-white scales. It is nearly twice as common in people with chronic hepatitis C as in those without.
  • Dermatomyositis: This inflammatory autoimmune disease causes muscle weakness and a distinctive skin rash. In addition to a reddish-purple rash around the eyes, there may be dark red bumps on the knuckles, elbows, ankles, or knees.
  • Erythema multiforme: This is a common skin reaction triggered by many different infections. It causes symmetric red, patchy skin lesions mostly on the arms and legs.
  • Erythema nodosum: This is a skin symptom common in people with inflammatory bowel disease that causes tender red bumps on larger bony surfaces on the front of the lower leg. In the absence of IBD, hepatitis C may be suspected.
  • Vitiligo: This is a condition that causes the destruction of pigment-producing skin cells called melanocytes, leading to patches of abnormally light skin. Hepatitis C may be suspected if vitiligo suddenly develops during adulthood.

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Hepatitis Affects The Whole Body

Having liver disease opens a gate through the body where the inflammation starts affecting the bloodstream. Hepatitis can have comorbidities with organs like the kidney, heart, lungs, skin, and bones.

Frequently, patients with hepatitis also forget its effect on periodontal diseases. So, teeth and gum problems like broken teeth are also common. Furthermore, there are more extensive connections of hepatitis skin rash that most patients dont recognize.

Rare and chronic diseases caused by agents that involve the skin are more than internal causes. Several types of hepatitis can be silent for many years. As people age and reach the senior stage, there are more visible signs of liver inflammation and diseases.

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Skin Signs Of Chronic Viral Hepatitis

At least 20% of patients with chronic hepatitis due to HBV or HCV develop skin changes, only a few of which are diagnostic of viral hepatitis.

Skin conditions associated with both HBV and HCV

Skin conditions more often associated with HBV

Skin conditions more often associated with HCV

Skin signs of possible hepatitis C infection

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Rare Forms Of Viral Hepatitis Caused By Agents Which Usually Involve Only The Skin

After primary infection, in the absence of any severe immune deficiency condition, herpesviruses like Herpes Simplex Viruses type 1 or 2, and Varicella-Zoster virus establish latency by remaining dormant in the dorsal root nerve ganglia. Viral reactivation results in cutaneous or muco-cutaneous manifestations that usually run an overall benign course , with an inflamed vesicular and/or bullous rash which is customarily restricted to a limited district of the body surface. Though in some patients rather impressive clinical scenarios may be observed , herpetic lesions tend to heal within few weeks, with no or only minor scarring and dyschromic sequelae. As for VZV, post-herpetic neuralgia develops quite rarely, and is the worst occurrence reported after skin manifestations have faded.

In otherwise healthy subjects, disseminated herpes simplex virus hepatitis have been reported very exceptionally. In one case described by Miyazaki and coworkers in 1991 , the possibility that patients mucosal herpetic lesions might have behaved as a gate for a large virus inoculum leading to visceral involvement either directly or after having overwhelmed local immune defenses has been considered.

Figure 1.

Herpes simplex on the foot: an unusual localization

Figure 3.

Severe cutaneous herpes simplex with extensive vesico-bullous elements

Figure 6.

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