Outcome of cutaneous psoriasis in hepatitis C virus‐infected patients treated with Direct‐Acting Antiviral therapy

Abstract

Apart from chronic liver disease, hepatitis C virus (HCV) may be responsible for several extra‐hepatic manifestations. Its involvement in psoriasis development is still controversial. The aim of this study was to evaluate the possible effect of anti‐HCV direct‐acting antiviral (DAA) treatment on cutaneous psoriasis. Thirty‐seven consecutive HCV patients with cutaneous psoriasis underwent efficacious DAA treatment, and all of them were efficiently cured as shown by HCV RNA negativity 24 weeks after stopping therapy (PT24W). An expert dermatologist evaluated the skin lesions at baseline, end of treatment (EOT) and PT24W using the psoriasis area severity index (PASI) scoring system. The impact on quality of life was measured with the Dermatologic Quality of Life Index (DLQI). Six patients had a stable disease throughout the study period, whereas 31/37 patients (83.8%) showed a significant improvement of the skin lesions at EOT (P < .0001). However, 24 of these 31 patients (77.4%) had a dramatic worsening of the psoriatic lesions at PT24W compared with EOT (P < .001), with lesion severity comparable to baseline. The outcome of psoriasis during and after treatment was independent of baseline PASI score, age, sex, HCV genotype, liver disease stage and of the presence of arterial hypertension, diabetes and autoimmune diseases. In conclusion, DAA‐based HCV cure has only a transient effect on skin lesions of patients with concomitant cutaneous psoriasis.

Over time evaluation of glycaemic control in direct‐acting antiviral‐treated hepatitis C virus/diabetic individuals with chronic hepatitis or with cirrhosis

“…[32][33][34] Of note, a transient benefit of HCV extrahepatic manifestation was very recently reported in HCV patients with cutaneous psoriasis who had a dramatic amelioration of cutaneous lesions under DAA treatment, but almost all the cases showed a similarly dramatic worsening of their skin disease, which-24 weeks after stopping treatment-returned comparable with the basal time. 10 To explain why the HCV recovery has only an initial, transient benefit on glucose metabolism in cases with advanced liver disease, one must consider both the multifactorial pathophysiological basis of diabetes and the large architectural, vascular and functional rearrangements occurring in the liver once cirrhosis is developed. Insulin resistance, muscle sarcopenia, deficit in hormones clearance and a 'toxic' effect on pancreatic islets are all suggested mechanisms determining an impairment of glucose metabolism in patients with liver cirrhosis, thus potentially contributing to the lack of long-term metabolic benefits of DAA treatment observed in these subjects.…”

Psoriasis and psoriasiform reactions secondary to immune checkpoint inhibitors

“…27 Psoriasis is also common as ADR, but its real incidence in course of ICIs has been not exactly estimated; several reports and case series have been published in the last years. 28,29 A literature review, linked to a case presentation, was recently proposed by De Bock et al 18 They checked a total of 35 cases of pso- forms; in one case also psoriatic arthritis was detected. 30 To the best of our knowledge, our study is the first that collected ICIs-related ADR reports using the European Medicine Agency database (EudraVigilance).…”

“…Psoriasis is also common as ADR, but its real incidence in course of ICIs has been not exactly estimated; several reports and case series have been published in the last years 28,29 …”

“…27 Psoriasis is also common as ADR, but its real incidence in course of ICIs has been not exactly estimated; several reports and case series have been published in the last years. 28,29 A literature review, linked to a case presentation, was recently proposed by De Bock et al 18 They checked a total of 35 cases of psoriasis flared during ICI therapy, now representing the largest database on this topic. According to their data, the majority of events occurred as an exacerbation of a pre-existing disease, although five reports of new onset psoriasis were reported.…”

Therapies with Antioxidant Potential in Psoriasis, Vitiligo, and Lichen Planus

“…In PSO patients, as demonstrated by many studies, detrimental external triggers such as cigarette smoking, air pollution, physical damage, and biological agents (viruses, bacteria, etc.) can contribute to keratinocyte damage [10,11]. Consequently, breaches in skin cell membranes lead to the release of inflammatory mediators and alarmins [12].…”