Skin findings In Hepatitis C

CRYOGLOBULINEMIA
Cryoglobulins are found in 19 to 54 percent of patients with HCV infection, symptoms occur in only 25 percent of these. The name literally means “cold antibody in the blood”, which refers to the chemical properties of the antibodies that cause this disease: cryoglobulins are antibodies that precipitate under cold conditions

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Hepatitis C is recognized as the most common cause of mixed cryoglobulinemia. Most of the people with cryoglobulinemia from hepatitis C have had their hepatitis for a long time or have cirrhosis. People with higher concentrations of hepatitis C RNA in their blood do not seem to have a higher risk of having cryoglobulinemia. Usually the cryoglobulins are in low concentration and cause no symptoms. About twenty-percent of people with hepatitis C and cryoglobulinemia have symptoms. Symptoms most often associated with cryoglobulinemia include mild fatigue, joint pains, or itching.

Occasionally, people with cryoglobulinemia develop vasculitis (inflammation of the blood vessels) which can cause purpura (purple skin lesions), Raynaud's phenomenon (the hands turn white, then blue, and then red from constriction and subsequent dilation of the blood vessels), or numbness in the hands and feet. The presence of cryoglobulinemia does not effect people's response to interferon. In fact, some people with vasculitis have improvement in the vasculitis as their liver tests improve on interferon.
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Related Information:

Rituximab Plus Peg-Interferon-alpha/Ribavirin Compared with Peg-Interferon-alpha/Ribavirin in Hepatitis C-Related Mixed Cryoglobulinemia

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CRYOGLOBULINEMIA
http://www.hcvadvocate.org/hcsp/articles/Bonkovsky-2.html

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Viruses - Hepatitis C

Dr. Anthony J. Perri, M.D.
Sunday, November 14, 2010 at 11:52AM

Hepatitis C (HCV) is a very common chronic viral infection that I encounter frequently in both my The Woodlands dermatology and Conroe dermatology clinics.

HCV is a single stranded RNA virus that is usually transmitted through exposure to HCV contaminated blood such as in blood transfusions that have not been properly screened or through IV drug use, unlike Hepatitis B virus which is usually sexually transmitted. Less than 1/3 of patients are symptomatic on initial infection with HCV.

Chronic infections occur in up to 80% of patients with HCV, which may present with liver cirrhosis, liver cancer or liver failure 10 to 20 years after the primary infection.

Skin findings are very common in HCV.

Vasculitis can occur which appears as palpable purpuric (bruises) papules and nodules. Cyroglobulinemia type 2 is due to a circulating cryoglobulin type 2 that can occur in 1% of all HCV patients and results in a leukocytoclastic vascultitis, livedo reticularis, and urticaria as the skin findings. Cryoglobulinemia can also cause inflammation of the joints, kidneys, and peripheral nerves. Porphyria Cutanea Tarda (PCT) is another skin disease due to HCV in which patients present with tense bullae (blisters) on the dorsum of their hands and forearms.

Lichen planus is a rash consisting of red itchy papules on the skin and white lacy patches and ulcers in the mouth that can be due to HCV. Necrolytic acral erythema is a skin rash unique to HCV in which patients develop scaly red plaques on their palms and soles. Most of the HCV dermatoses respond to treatment of the HCV infection with Interferon and Ribavirin

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Hepatitis C- Cryoglobulinemia

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