Hepatitis C virus-associated cutaneous disorders:: Differential diagnosis

Hepatitis C virus (HCV) is a single stranded RNA virus that was described in 1989. The prevalence of the virus is high in intravenous drug users, homosexuals, prostitutes, transplant recipients, and medical staff. Half of the patients with acute hepatitis C infection will develop chronic disease and 20% of these patients will progress to cirrhosis or develop hepatocellular carcinoma. Recent reports focused on the association between HCV infection and many dermatoses. Pruritus, porphiria cutanea tarda, vasculitis, salivary gland lesions, lichen planus, necrolytic acral erythema are known to accompany HCV infection. Hepatitis associated pruritus is mainly due of cholestasis. However, reports suggest that some non-bile pruritogens that bind to hepatocyte membrane may also cause pruritus. HCV infection is present in 10 to 80% of patients with porphiria cutanea tarda. Mixed cryoglobulinemia, polyarteritis nodosa, and leukocytoclastic vasculitis may accompany HCV infection. Besides, lymphocytic sialadenitis similar to that in Sjogren's syndrome is present in 57% of patients with HCV infection. Lichen planus may also be detected in patients with HCV. Review of the literature reveals cases with nekrolytic acral erythema, erythema nodosum, erythema multiforme, antiphospholipid syndrome, serum IgE level elevation, sarcoidosis, urticaria, urticarial vasculitis, panniculitis, pyoderma gangrenosum, dermatomyositis, malakoplakia, and epidermolysis bullosa acquisita accompanying to HCV infection. In the treatment of HCV infection, interferon-alpha is widely used with reported cutaneous side effects such as acne, nail deformities, photosensitivity, skin pigmentation, exfoliative dermatitis, Raynaud's phenomenon, pemphigus and erysipelas. In conclusion, patients with HCV may be diagnosed based on cutaneous manifestations and early diagnosis of the HCV infection may be life saving and increase the therapeutic success.