Dermatologists have unique chance for early HCV detection

New York - Hepatitis C, a disease of the liver caused by the hepatitis C virus (HCV), infects some 4 million people in the United States, or nearly 2 percent of the population.

As is the case with most diseases, early detection and treatment can minimize the effects of hepatitis C - and according to J. Mark Jackson, M.D., dermatologists are in a unique position to detect the disease early.

"The skin is a marker, a map, for internal diseases," says Dr. Jackson, associate clinical professor of medicine and dermatology at the University of Louisville's Division of Dermatology. "Because dermatologists often are the first ones to see patients who come in with a rash that may be an indication of something far more serious, we're in a position to detect it and get the patient early treatment."

"Hepatitis C runs a chronic course in 50 to 70 percent of patients it infects, cirrhosis develops in 20 to 30 percent of them, and hepatocellular carcinoma in about 4 percent," he says. "Cutaneous manifestations are often the first clue to the diagnosis of HCV infection."

Three major examples Dr. Jackson cited three major examples of cutaneous manifestations of HCV: cryoglobulinemia, leukocytoclastic vasculitis (LCV) and porphyria cutanea tarda (PCT). Characteristics of each include:

"Types II and III are called mixed cryoglobulinemias and occur in patients with HCV," Dr. Jackson says. "Cryoglobulins are immune complexes that precipitate at low temperatures and may include a rheumatoid factor."

Dr. Jackson says the following cutaneous findings occur in 60 percent to 70 percent of patients infected with HCV: palpable purpura, livedo reticularis, acrocyanosis, urticaria, ulceration and hemorrhagic bullae.

"The mechanism for lichen planus is unknown, but it's thought to be immune-mediated," he says. "Incidence ranges from one-tenth of a percent to 35 percent of HCV patients, and is higher in those with generalized or mucosal - especially ulcerated - lichen planus."

Dr. Jackson says more than one-third of HCV-positive patients display symptoms of Sjogren's syndrome, while a like percentage of patients with polyarteritis nodosa are seropositive for HCV.