What to know about hepatitis C and psoriasis

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Psoriasis is an inflammatory skin disorder that causes the skin cells to multiply much faster than they normally would, and faster than the body can shed away. This leads to a buildup of these cells, which appears as irregular red patches of skin with white scaling.

Psoriasis is an autoimmune condition. Each person may have their own set of triggers that may lead to the forming of psoriasis scales, such as stress, temperature, and infection.

Hepatitis refers to inflammation in the liver, typically in response to injury or infection. Hepatitis C is an infection caused by the hepatitis C virus (HCV). The virus attacks the liver, leading to inflammation. A person can acquire the infection through contact with contaminated blood.

In some cases, hepatitis C may be a short-term illness, but for others it becomes a long-term, chronic infection. Many people may not realize they have a HCV infection as it typically does not present with symptoms. However, a chronic HCV infection can result in the development of other conditions.

There is no direct connection between hepatitis C and psoriasis, meaning that one does not cause the other and having one does not indicate that the person will have the other.

However, medical research suggests they may have a less direct connection. A 2017 study notes a higher rate of HCV infections in adults who have psoriasis compared to those who do not. Additionally, those with moderate to severe psoriasis who had hepatitis C were more likely to experience a worsening of their liver.

The two conditions share some links that could explain the connection. While HCV affects the liver, it can also affect the skin, and trigger conditions such as psoriasis. In some people, a HCV infection may lead to dysregulation of the immune system. Psoriasis is a skin condition that stems from a dysregulated immune system.

Additionally, the course of hepatitic C and its treatment may play a role. The amount of stress the body goes through during a HCV infection may trigger symptoms of psoriasis. Additionally, psoriasis may develop as a side effect of some medications that treat chronic hepatitis C.

Psoriasis can increase the risk of infections. This risk increases further if a person with psoriasis receives immunosuppressant treatment that modulates their immune system. This does not mean psoriasis will result in a HCV infection, but that a person is at a higher risk of infections including a HCV infection.

Conversely, there may also be a link between treatment for hepatitic C and psoriasis symptoms going away. A 2018 case study reports on a person with both conditions receiving antiviral treatment for the HCV infection, which also improved symptoms of psoriasis. This suggests that reducing immune dysregulation may be key for treating both conditions. However, further research is necessary.

Symptoms of psoriasis may vary slightly from person to person, but the characteristic symptoms are patches of red skin with white scaling. These scales may itch and sting. They can occur anywhere, but some common sites include the scalp, elbows, and knees.

Doctors typically diagnose psoriasis based on a physical examination. They may ask questions about the joints or other areas of the body to determine the extent of the psoriasis. They might also carry out a skin biopsy to rule out other conditions, such as eczema.

Typically, people with a HCV infection do not present any symptoms. This makes regular screening for hepatitis C important, especially for people with psoriasis taking immunosuppressive drugs. Some people with an acute hepatitis C infection may have symptoms 1-3 months after viral exposure, which can include:

• fatigue
• fever
• nausea
• vomiting
• very dark urine
• gray or clay-colored stools
• loss of appetite
• joint pain
• abdomen pain
• jaundice, a yellowing of the skin or eyes

Doctors will diagnose hepatitis C by asking about medical history and doing a physical exam to check on the person’s symptoms. If they suspect hepatitis C, a blood test can help confirm their diagnosis.

Treatment of people who have both hepatitis C and psoriasis together may vary. A person will have to work closely with a hepatologist, which is a doctor specializing in the liver.

A doctor may suggest using interferon drugs to treat a HCV infection. However, these drugs may exacerbate symptoms in some people with psoriasis. Alternatively, a doctor may suggest direct-acting antiviral agents (DAA), as they may be more effective and less likely to cause adverse effects.

Treatment for hepatitis C may last for 8–24 weeks. While psoriasis symptoms may get worse during this time, they will likely get better after finishing treatment.

Treatment for psoriasis involves controlling the symptoms as best as possible. This may include a number of injected or topical solutions. In some cases, doctors may also prescribe biologics or immunosuppressants. While it is not ideal to use immunosuppressive drugs during treatment for HCV, research suggests using DAAs alongside immunosuppressants may be relatively safe.

People with these two conditions together may face possible complications from treatment, and should consult their doctor about them. For example, if a person with psoriasis has a HCV infection, a doctor may suggest stopping any immunosuppressants while treating the infection. This is in order to help keep the immune system healthy while fighting off the infection.

A 2020 study notes possible connections between drugs such as biologics used to treat psoriasis and a reactivation of HCV infection. However, the research indicates that the rates of hepatitis C were low among all psoriasis treatment types.

Without proper treatment, possible complications for hepatitis C include cirrhosis, liver failure, and liver cancer. Psoriasis can also result in a wide range of complications and comorbidities.

Because people with psoriasis are at higher risk for severe infection, it is important for them to take steps to avoid HCV infection. HCV can spread through blood or, rarely, other bodily fluids. Steps to prevent infection include:

• not sharing drug needles or other drug materials
• wearing gloves when touching another person’s open sores or blood
• ensuring tattoo artists or body piercers use sterile tools and fresh ink
• not sharing personal items that may contact blood, such as razors, toothbrushes, and nail clippers
• avoiding unprotected rough or anal sex

Even if a person has had hepatitis C in the past, they can still get the infection again. A person with hepatitis C who starts to notice signs of psoriasis should talk to their doctor so they can begin treatment as soon as possible.

Hepatitis C and psoriasis do not share a direct connection, but research suggests that the conditions may relate to each other. Hepatitis C does not cause psoriasis, but may trigger the condition in people with a predisposition to it. People with psoriasis are at a higher risk for contracting infections such as hepatitis C.

Treatments for both conditions may interact, exacerbate symptoms, and potentially result in other complications. Therefore, it is important that a person with both conditions work closely with a doctor and follow their advice on which treatments to use.

Read this article in Spanish.