Extrahepatic manifestations may be important clues in the diagnosis of hepatitis C infection.


Hepatitis C is well known for its effect on liver function and its potential to cause cirrhosis. However, chronic hepatitis C infection (HCVI) is also associated with a comprehensive burden that may include extrahepatic manifestations. Nearly three-fourths (74%) of patients with chronic HCVI may experience these symptoms. 

Extrahepatic manifestations are diverse, and may cause problems with almost any highly vascularized organ system. Conditions resulting from HCVI range from lymphoproliferative disorders to cutaneous manifestations, such as purpurea or lichen planus. 

Porphyria cutanea tarda

Porphyria cutanea tarda, or PCT, manifests in nearly two-thirds (66%) of patients with HCVI, and may appear as blisters, vesicles, or millia on the skin—most often on the hands. Porphyria is a purplish pigmentation of the skin that may result in neurological manifestations and skin manifestations due to improper processing of heme due to defective enzyme systems.

Current estimates indicate that 47% to 50% of patients with porphyria cutanea tarda may have chronic HCVI.

Lichen planus

Another cutaneous manifestation, lichen planus, may affect any squamous epithelial surface. For instance, the inside of the mouth is composed of stratified squamous epithelium.

The wrists, hands, ankles, lower back, shins, and genitals may also be affected. Lichen planus may have a purple hue and often results in intense pruritus on affected areas. More than one-fourth (29%) of patients with lichen planus have HCV.

Mixed cryoglobulinemia

Chronic HCVI may cause abnormal protein folding, resulting in immune complexes that circulate in the blood and deposit on small blood vessels, disrupting the function of the skin, kidneys, and peripheral nerves. One hallmark of this condition, known as mixed cryoglobulinemia, is the presence of proteins that are insoluble in the blood and precipitate out of blood samples at low temperatures. 

In addition to cutaneous signs and organ damage, mixed cryoglobulinemia may cause joint pain (arthralgia) and a persistent feeling of weakness. Of all cases of mixed cryoglobulinemia, approximately 8 in 10 are due to HCV infection.

Extrahepatic manifestations are an important sign of HCV infection. Patients with any of these symptoms should be advised to seek testing for HCV.

With curative treatment, many patients may experience resolution of extrahepatic manifestations. Familiarity with the signs of extrahepatic manifestations is an important method of identifying patients who are good candidates for screening, particularly in the era of highly active curative treatments for HCV.

Reference
Dedania B, Wu GY. Dermatologic Extrahepatic Manifestations of Hepatitis C. J Clin Transl Hepatol. 2015;3(2):127-133.