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 impacts others. Hepatitis C, for example, can often manifest in the body’s largest organ, the skin. Here’s how hepatitis C causes skin issues — and what you can do to correct the problems.
How Does Hepatitis C Affect Your Body?
Hepatitis C is an inflammation of the liver. The hepatitis C virus (HCV) is most often transmitted through infected blood, such as by sharing needles, says Alexander Kuo, MD, medical director of liver transplantation at Cedars-Sinai in Los Angeles. Sexual transmission is very uncommon, he says. In healthy adults, you’re more likely to catch HCV by sharing a toothbrush or razor than through sexual contact. Using barrier methods during sex decreases the risk further. People who contract HCV often don’t realize they have it. “During the early stages of infection, the vast majority of people are symptom free,” Dr. Kuo says, so it can be difficult to diagnose before it has already done lasting damage to your liver. People who may have been exposed — children of women who have hepatitis C; people who have gotten at-home tattoos; and those who’ve used intravenous drugs — should get a onetime blood test to screen for HCV even before they experience symptoms, according to the Centers for Disease Control and Prevention (CDC). People who actively inject drugs should have routine screenings. Over time, the chronic inflammation from untreated hepatitis C can lead to fibrosis, or scarring, in the liver. Kuo cautions that if this continues for 20 or more years, there is a risk that the liver can become hard from severe fibrosis, resulting in a condition called cirrhosis. “People with cirrhosis are at risk of liver cancer or symptoms of liver dysfunction, such as bleeding in the gastrointestinal tract,” Kuo says.
Skin Conditions Associated with Hepatitis C
Poor liver function can have serious adverse effects on your skin health. While 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 are a few skin conditions caused by hepatitis C.
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.
Pruritus
Pruitis is an intense, itching sensation that can appear all over the body — and a common symptom of chronic hepatitis C that appears on the skin, according to a study published in February 2017 in the World Journal of Gastroenterology. One theory is that the hepatitis C virus 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 anti-pruritics (such as camphor lotion) can help stop the itch.
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 review published in February 2019 in the journal Experimental and Therapeutic Medicine noted that although several theories have been suggested, “None of them clearly explain” the association between the two. How to treat it: Like mixed cryoglobulinemia, the most effective treatment for HCV-related LP is treating the hepatitis itself. One small study published in July 2016 in the journal Clinical and Translational Gastroenterology found that the direct-acting antiviral 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 in 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.
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 your blood. How to treat it: The only way to treat jaundice from hepatitis C is to treat the infection itself. In addition, 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 to avoid adding any undue stress to your liver, according to Cleveland Clinic.
Easy bruising
Poor liver function 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, as with bruising, raise the injured area above your heart, to slow bleeding, but if the bleeding doesn’t stop, seek medical attention.
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 usually not serious, and simple mitigation strategies — keeping your home warm, wearing socks and gloves, exercising regularly to improve your circulation — are effective. Avoiding things that narrow your capillaries, such as smoking, caffeine, and salty food, is also important.
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. When the liver is damaged from hepatitis C, it can’t metabolize estrogen as effectively. How to treat it: Spider angiomas are usually harmless, but they can be unsightly, especially if they appear on your face and neck. A dermatologist can clear spider angiomas 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 direct-acting antiviral 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, direct-acting antivirals are also safe and have minimal side effects. Once the hepatitis C is treated, all related skin issues should clear as well.
