Systematic Reviews
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World J Gastroenterol. Nov 14, 2014; 20(42): 15860-15866
Published online Nov 14, 2014. doi: 10.3748/wjg.v20.i42.15860
Spontaneous and antiviral-induced cutaneous lesions in chronic hepatitis B virus infection
Ioana Grigorescu, Dan Lucian Dumitrascu
Ioana Grigorescu, Dan Lucian Dumitrascu, 2nd Department of Internal Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, 400006 Cluj-Napoca, Romania
Author contributions: Grigorescu I performed the literature research and wrote the paper; Dumitrascu DL designed the paper, participated in the analysis of the data, and contributed to the writing of the manuscript.
Correspondence to: Dan Lucian Dumitrascu, MD, Professor, Head of the 2nd Department Internal Medicine, University of Medicine and Pharmacy “Iuliu Hatieganu”, Clinicilor Street 2-4, 400006 Cluj-Napoca, Romania. ddumitrascu@umfcluj.ro
Telephone: +40-264-593355 Fax: +40-264-596912
Received: October 28, 2013
Revised: March 3, 2014
Accepted: June 13, 2014
Published online: November 14, 2014
Abstract

AIM: To describe spontaneous, or interferon (IFN)- or immunization-induced skin lesions in hepatitis B virus (HBV) infection.

METHODS: A comprehensive literature search of all the papers presenting case reports of dermatological lesions in patients with chronic HBV infection was carried out. We included only patients with histologically proven skin lesions that appeared in the normal course of hepatitis B infection, or after immunization for hepatitis B or antiviral treatment.

RESULTS: We found 44 papers on this topic, reporting 151 cases. About 2% of patients with hepatitis B infection, mainly men, presented with skin lesions. Among patients with chronic hepatitis B, vasculitis and essential mixed cryoglobulinemia seemed to be the most frequent skin lesion (53.3%), followed by papular changes, rashes and Gianotti-Crosti syndrome, skin carcinoma and Henoch-Schönlein purpura were rare. IFN treatment seemed to be effective against HBV-associated and immunoglobulin-complex-mediated disease (vasculitis). Two cutaneous lesions (lichen planus and granuloma annulare) were described after hepatitis B vaccination. Systemic lupus and lupus-like lesions were the most frequently encountered lesions after antiviral treatment. Immunosuppressive and steroid therapy ameliorates lichen planus lesions in 50% of cases.

CONCLUSION: Vasculitis was the most frequent spontaneous skin lesion found in chronic hepatitis B. Lichen planus was most frequent after immunization and lupus/lupus-like lesions after IFN.

Keywords: Hepatitis B, Skin diseases, Adverse effects, Immunization

Core tip: Chronic hepatitis B is a common infection with various etiologies, including the involvement of several systems. We investigated the skin lesions of patients with chronic or acute hepatitis B. We also looked for skin lesions related to vaccination and antiviral therapy. Most common lesions in chronic hepatitis B virus infection encountered in a comprehensive literature search are: 41% essential mixed cryoglobulinemia and 15.3% vasculitis; 10.5% (lichen planus-like lesions) respectiveley 7.2% of all lesions included in the review were associated with immunization (lichen planus) and antiviral therapy (lupus-like lesions).