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Residents Forum
RF- Are the New Direct-Acting Antiviral Agents Effective for Treating the Cutaneous Manifestations of Hepatitis C?
FR-¿Son los nuevos agentes antivirales de acción directa un tratamiento eficaz para las manifestaciones cutáneas de la hepatitis C?
D. Morgado-Carrasco
Autor para correspondencia
danielmorgado@yahoo.com.ar

Corresponding author.
, X. Fustà-Novell, S. Podlipnik, P. Giavedoni
Dermatology Department, Hospital Clínic, Barcelona, Spain
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        "titulo" => "FR-&#191;Son los nuevos agentes antivirales de acci&#243;n directa un tratamiento eficaz para las manifestaciones cut&#225;neas de la hepatitis <span class="elsevierStyleSmallCaps">C</span>&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The hepatitis C virus &#40;HCV&#41; is one of the most common causes of chronic liver disease worldwide&#46; The virus increases the risk of liver cirrhosis and hepatocellular carcinoma&#46; HCV is associated with numerous extrahepatic manifestations&#44; such as type 2 diabetes mellitus&#44; chronic kidney disease&#44; cardiovascular disease&#44; non-Hodgkin lymphomas&#44; and various skin diseases &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; Patients infected with HCV may have symptomatic mixed cryoglobulinemia &#40;cryoglobulinemic vasculitis&#41;&#44; which has an estimated prevalence of 4&#46;9&#37;&#44; as well as porphyria cutanea tarda and lichen planus&#44; with a relative risk 2 and 8 times that of the general population&#44; respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Other skin disorders possibly associated with HCV are psoriasis&#44; alopecia&#44; pruritus&#44; polyarteritis nodosa&#44; sarcoidosis&#44; and necrolytic migratory erythema&#46; Urticaria&#44; Beh&#231;et disease&#44; erythema nodosum&#44; and erythema multiforme have also been reported&#44; although the association is less clear&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The recent introduction of the latest generation of direct acting antivirals &#40;DAAs&#41;&#8212;including sofosbuvir&#44; ledipasvir&#44; daclatasvir&#44; asunaprevir&#44; and others&#8212;has revolutionized the treatment of chronic HCV infection due to the very high effectiveness&#44; excellent safety profile&#44; and tolerability of these drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Current clinical guidelines &#40;September 2016&#41; suggest initiating treatment in all patients with chronic HCV infection except those with limited life expectancy&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Recently there have been reports of improvement in skin diseases associated with HCV after successful treatment with DAAs&#46; A prospective study in Spain of 64 patients with mixed cryoglobulinemia secondary to HCV infection&#44; 35 of whom had manifestations of cryoglobulinemic vasculitis&#8212;including purpura &#40;65&#37;&#44; 23 of 35 patients&#41;&#44; joint or muscle pain &#40;51&#37;&#41;&#44; and neurologic or renal involvement &#40;70&#37;&#41;&#8212;found that complete clinical response was achieved in 71&#37; of symptomatic patients after therapy with various combinations of DAAs&#46; In the patients who had purpura&#44; cutaneous involvement remitted after sustained virological response &#40;SVR&#41; in nearly all cases &#40;21 of 23 patients&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Nagao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> presented a series of 7 patients with HCV and oral lichen planus&#8212;4 with erosive lichen planus &#40;3 of whom were previously treated with topical corticosteroids&#41;&#8212;who received daclatasvir-asunaprevir combination therapy with SVR&#59; complete resolution of oral disease was achieved in 4 patients and partial improvement was achieved in 3&#46; Finally&#44; Tong et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> described 3 individuals diagnosed with porphyria cutanea tarda and HCV infection who were successfully treated with ledipasvir-sofosbuvir combination therapy&#46; Remission of cutaneous symptoms was achieved in 2 patients&#44; and a marked decrease in the number of erosive lesions was achieved in the third patient between 1 and 3 months after completion of antiviral therapy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; DAAs are highly effective and safe for the treatment of HCV infection&#46; Some reports suggest that DAAs could also achieve improvement in some skin diseases associated with HCV and that these drugs could perhaps be a therapeutic option for patients with aggressive skin disorders or who do not respond to conventional treatments&#46; Given that the use of these drugs is expected to increase&#44; we will be able to see whether these effects occur in a larger number of patients and if the effects persist over time&#46;</p></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Source&#58; Younossi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p>"
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                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Well-established association</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Uncertain association</span>&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Extrahepatic manifestations of hepatitis C&#58; A meta-analysis of prevalence&#44; quality of life&#44; and economic burden"
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                        "volumen" => "150"
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                  "comentario" => "pii&#58; S1542-3565&#40;16&#41;30878-3"
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                      "titulo" => "Virologic&#44; clinical&#44; and immune response outcomes of patients with hepatitis C virus-associated cryoglobulinemia treated with direct-acting antivirals"
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                            1 => "S&#46; Lens"
                            2 => "M&#46;C&#46; Londo&#241;o"
                            3 => "Z&#46; Mari&#241;o"
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                            5 => "M&#46; Ramos-Casals"
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                  "referenciaCompleta" => "AASLD-IDSA&#46; Recommendations for testing&#44; managing&#44; and treating hepatitis C&#46; <a href="http://www.hcvguidelines.org/">http&#58;&#47;&#47;www&#46;hcvguidelines&#46;org</a>&#46; Accessed October 23&#44; 2016&#46;"
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