Hepatitis C Skin Conditions

It’s widely known that hepatitis C (HCV) can damage your liver and eventually lead to advanced liver disease. More surprising, though, is that hepatitis C can also cause changes to your skin.

Your organs all work in tandem, and a chronic infection that affects one of them — in this case, the liver — can trigger a domino effect that ultimately has an impact on others. Hepatitis C, for example, can often manifest in the body’s largest organ, the skin.

Poor liver function — which can result from a hepatitis C infection — can also have serious adverse effects on skin health, says Alexander Kuo, MD, medical director of liver transplantation at Cedars-Sinai in Los Angeles.

While Dr. Kuo stresses that treating and curing hepatitis C is the only surefire way to get rid of HCV-related skin issues, there may be some ways to mitigate the symptoms.

Here’s how hepatitis C causes skin issues — and what you can do to correct the problems.

Skin Conditions Associated with Hepatitis C

Some skin conditions are linked to hepatitis C itself, including:

Mixed Cryoglobulinemia

“Mixed cryoglobulinemia is the most common skin disorder associated with hepatitis C infection,” says Kuo. This happens when HCV particles deposit in your small blood vessels, making them inflamed. They then appear on your skin as raised, rash-like red spots known as purpura — and in some extreme cases, skin ulcers.

How to treat it: If this condition is caused by HCV, the only way to cure it is by treating the infection itself, says Kuo.

Lichen Planus

Lichen planus (LP) is a skin condition that primarily appears on your wrists and arms as flat, scaly bumps that are purple or red and can lead to swelling, itching, and irritation. In people with hepatitis C, it can appear inside the mouth, where it causes irritated white patches and sores.

Although there appears to be a link between LP and HCV, the connection is still a bit of a mystery. A study published in Clinical Oral Investigations in April 2022 notes that one theory as to why they’re correlated is that the LP virus attracts HCV T-cells in the mucus in the mouth.

How to treat it: Like mixed cryoglobulinemia, the most effective treatment for HCV-related LP is treating the hepatitis itself. The same study found that the direct-acting antiviral (DAA) medications used to treat HCV were effective in treating oral LP as well. Lifestyle changes, such as practicing good dental hygiene and avoiding spicy or acidic foods, can also help relieve irritation.

Porphyria Cutanea Tarda

Porphyria cutanea tarda (PCT) is another common skin condition among people who have chronic hepatitis C. It causes extreme sensitivity to sunlight (and even some artificial light), resulting in hyperpigmentation, blisters, ulceration, and scarring.

PCT occurs when your liver doesn’t properly synthesize porphyrin, a compound that is important for helping carry oxygen to your cells. When porphyrin builds up in your body, it can make your skin fragile and sensitive to light and even make your hair grow excessively.

Unlike LP, there’s strong evidence that HCV and PCT are directly connected. “The majority of cases of PCT involve people with chronic liver disease caused by HCV, alcohol, or iron overload,” Kuo adds.

How to treat it: Because PCT causes extreme photosensitivity, avoiding the sun and wearing sunblock or long sleeves and pants are your first lines of defense against it. Avoiding drinking, smoking, and drugs is also important to keep your liver healthy, says Kuo. Most cases will clear up after a course of hepatitis C treatment.

Raynaud’s Syndrome

Raynaud’s syndrome occurs when parts of your body, especially your fingers and toes, suddenly feel cold and numb and go pale or turn blue in response to cold or stress. When warmed again, they can become red and inflamed. While the cause of Raynaud’s syndrome is unknown, scientists speculate that it may be caused by thicker blood from excess red blood cells or narrowed capillaries.

How to treat it: Raynaud’s syndrome is not usually serious, and simple mitigation strategies — keeping your home warm, wearing socks and gloves, exercising regularly to improve your circulation — are effective. Taking calcium channel blockers can also help. Avoiding things that narrow your capillaries, such as smoking, caffeine, and salty food, is also important.

Skin Conditions Associated with Liver Disease

Other skin conditions develop in people who have liver disease, including:

Pruritus

Pruritus, an intense itch that can appear anywhere on your body, is a common skin symptom of chronic hepatitis C, according to a study published in February 2021 in Scientific Reports. One theory is that HCV ramps up the body’s production of cytokines, which are small proteins that help the immune system function.

How to treat it: Moisturizers and topical antipruritics (such as camphor lotion) can help stop the itch.

Jaundice

Jaundice, or yellowing of the skin and eyes, is a well-known skin condition associated with liver failure in general, not just hepatitis C. It usually occurs when the liver isn’t processing red blood cells properly and a substance called bilirubin builds up in the blood.

How to treat it: The only way to treat jaundice from hepatitis C is to treat the HCV infection itself. In addition, to avoid adding any undue stress to your liver, it’s important to stop drinking all alcohol and taking any medications (including over-the-counter painkillers and supplements) that aren’t prescribed by your doctor, according to Cleveland Clinic.

Easy Bruising

Poor liver function makes it harder for blood to clot and reduces the number of platelets in your blood, which can make you susceptible to bruising and uncontrolled bleeding. Sudden, easy bruising can be a sign of advanced liver disease, so it’s important to seek medical attention if this symptom arises.

How to treat it: Prevention is key here. Avoid high-impact activities that put you at risk of injury. At the first sign of a bruise, elevate the affected area above your heart and apply ice. This can prevent the bruise from spreading. If you cut yourself, raise the injured area above your heart to slow bleeding, as you would with bruising, but if the bleeding doesn’t stop, seek medical attention.

Spider Angiomas

Spider angiomas are small red spots that usually pop up on your face, neck, and trunk area and look like spider webs. A telltale characteristic of spider angiomas is that they drain and turn white when you apply pressure to them and turn red again when you release. Unlike Raynaud’s, they’re caused by dilating blood vessels, usually from higher estrogen levels in the blood.

How to treat it: Spider angiomas are usually harmless, but if they make you self-conscious, especially if they appear on your face and neck, a dermatologist can clear them using a laser, electric current, or injection that collapses the vein.

Spider angiomas can reappear after these treatments, though, so the best way to get rid of them for good is to treat your HCV.

Treating Hepatitis C Can Help Alleviate Skin Conditions

The good news is that there have been great advancements in the treatment of chronic hepatitis C using DAA medications, which reduce the viral load significantly enough to cure the infection.

“They involve taking pills once a day for eight to 12 weeks, with cure rates above 95 percent,” says Kuo. Unlike past treatments for hepatitis C, DAAs are also safe and have minimal side effects. Once the hepatitis C is treated, all related skin issues should clear as well.