Psoriasis as a Manifestation of an Immune Reconstitution in Two Patients with Hepatitis C Treated with Ledipasvir/Sofosbuvir

Direct‐acting antiviral drugs are triggers for psoriasis: report of three cases

“…There are a few reports demonstrating the relationship between the new DAAs and psoriasis, justifying the importance of our report.…”

“…In one report, the patient developed erythema multiforme associated with erythrodermic psoriasis induced by SOF and DCV . In the other one, two patients showed worsening of previous psoriasis after 2 months of therapy with SOF and ledipasvir …”

Direct acting antiviral‐induced/exacerbated psoriasis: Addendum!

“…These reports drew our attention to review. As we reviewed these reports, we came to certain observations that might be of significance to both patients and treating physicians (Heppt & Sticherling, ; Oliveira et al, ; Wang & Liu, ). We observed the following: (a) total number of the reported cases in the three published reports were only six patients; (b) male: female ratio was 2:1; (c) all of the patients were above 40 years; (d) all had history of chronic plaque psoriasis, except one; (e) initial anti‐psoriatic therapies before DAAs were: (i) traditional Chinese medicine, and ultraviolet irradiation, (ii) pegylated interferon (IFN)‐α and ribavirin, (iii) topical remedies/narrowband‐ultraviolet B (NB‐UVB); (f) the reactions developed within 23–90 days post‐initiation of DAAs; (g) all showed exacerbation of chronic plaque psoriasis, except one who developed erythrodermic psoriasis and erythema multiforme; (h) treat through, maintaining the treatment with DAAs (with greater improvement on discontinuation) in three cases and improvement in one patient within 7 weeks without withdrawal of the DAAs; (i) topical therapy and/or NB‐UVB were the main treatment options; (j) only one case required cyclosporine (erythrodermic psoriasis); (k) three patients had history of hepatic cirrhosis, a known risk factor for hepatocellular carcinoma.…”

“…Experts suggested that DAAs do not have direct carcinogenic effects. (l) DAA‐induced or exacerbated psoriasis condition has no clear explanation, however it could be explained by direct immunological drug effects or by immune‐infectious changes (“reconstitution” syndrome with DAAs) (Heppt & Sticherling, ; Najafi Fard et al, ). The reported cases of DAAs‐induced/exacerbated psoriasis were summarized in Table .…”

“…These reports drew our attention to review. As we reviewed these reports, we came to certain observations that might be of significance to both patients and treating physicians (Heppt & Sticherling, 2017;Oliveira et al, 2018;Wang & Liu, 2017). We observed the following: (a) total number of the reported cases in the three published reports were only six patients; (b) male: female ratio was 2:1;…”