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World J Hepatol. Nov 28, 2015; 7(27): 2740-2748
Published online Nov 28, 2015. doi: 10.4254/wjh.v7.i27.2740
Cutaneous manifestations of hepatitis C in the era of new antiviral agents
Simone Garcovich, Matteo Garcovich, Rodolfo Capizzi, Antonio Gasbarrini, Maria Assunta Zocco
Simone Garcovich, Rodolfo Capizzi, Department of Dermatology, Policlinico A. Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
Matteo Garcovich, Antonio Gasbarrini, Maria Assunta Zocco, UOC Internal Medicine and Gastroenterology, Policlinico A. Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
Author contributions: Garcovich S contributed to the revision of the literature, to the drawing up the review and to the figures; Garcovich M contributed to the revision of the literature, the drawing up of the review and to the revision of the English; Capizzi R contributed to the revision of the review, to the revision of the literature and to the bibliography; Gasbarrini A contributed to the revision of the review, to the revision of the literature and to the bibliography; Zocco MA contributed to the revision of the review, to the revision of the English and to the final approval of the article to be published.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Matteo Garcovich, UOC Internal Medicine and Gastroenterology, Policlinico A. Gemelli, Catholic University of Sacred Heart, Largo A. Gemelli, 8, 00168 Rome, Italy. matteogarcovich@yahoo.it
Telephone: +39-06-30156018 Fax: +39-06-35502775
Received: July 15, 2015
Peer-review started: July 24, 2015
First decision: September 22, 2015
Revised: October 23, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: November 28, 2015
Processing time: 128 Days and 11.8 Hours
Abstract

The association of chronic hepatitis C virus (HCV) infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature, with varying strength of epidemiological association. Skin diseases which are certainly related with chronic HCV infection due to a strong epidemiological and pathogenetic association are mixed cryoglobulinemia, lichen planus and porphyria cutanea tarda. Chronic pruritus and necrolytic acral erythema are conditions that may share a possible association with HCV infection, while several immune-mediated inflammatory skin conditions, such as psoriasis, chronic urticaria and vitiligo, have been only anecdotally reported in the setting of chronic HCV infection. Traditional interferon-based treatment regimens for HCV infection are associated with substantial toxicity and a high-risk of immune-related adverse events, while the advent of new direct-acting antivirals with sustained virological response and improved tolerability will open the door for all-oral, interferon-free regimens. In the new era of these direct acting antivirals there will be hopefully a renewed interest in extra-hepatic manifestations of HCV infection. The aim of the present paper is to review the main cutaneous HCV-related disorders - mixed cryoglobulinemia, lichen planus, porphyria cutanea tarda and chronic pruritus - and to discuss the potential impact of new antiviral treatments on the course of these extra-hepatic manifestations of chronic HCV infection.

Keywords: Chronic liver disease; Hepatitis C virus; Interferon-free agents; Extra-hepatic manifestation; Skin diseases; Mixed cryoglobulinemia; Lichen planus

Core tip: It is known that the association of hepatitis C virus (HCV) infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature. In the new era of direct acting antivirals there will be hopefully a renewed interest in the diagnosis and treatment of extra-hepatic manifestations of HCV infection. The aim of the present paper is to review the main cutaneous HCV-related disorders and to discuss the potential impact of new antiviral treatments on the course of these extra-hepatic manifestations of chronic HCV infection in order to help all the clinicians dealing with patients undergoing antiviral treatment.