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Cutaneous Manifestations of Sexually Transmitted Disease in the HIV-Positive Patient
Published in Clay J. Cockerell, Antoanella Calame, Cutaneous Manifestations of HIV Disease, 2012
Bryan Gammon, Antoanella Calame, Clay J. Cockerell
While hepatocytes are the primary site of infection, there is a growing body of evidence suggesting that HCV can efficiently replicate in extrahepatic tissue leading to a variety of extrahepatic clinical manifestations.344 Extrahepatic disease in HCV is actually quite common and in one large prospective study, 74% of patients reported at least one extrahepatic clinical manifestation.345 HCV is associated with number of dermatologic diseases including lichen planus (LP), porphyria cutanea tarda (PCT), mixed cryoglobulinemia, and the more recently described necrolytic acral erythema.
Uncommon immune-mediated extrahepatic manifestations of HCV infection
Published in Expert Review of Clinical Immunology, 2018
Ciro Romano, Giovanna Cuomo, Roberta Ferrara, Andrea Del Mastro, Sergio Esposito, Ausilia Sellitto, Luigi Elio Adinolfi
Necrolytic acral erythema (NAE) is a rare, psoriasiform dermatologic disorder with a similar histopathologic appearance. Lesions are typically localized on lower extremities and are constituted by erythematous to hypopigmented plaques with variable scaling [46]. Association of NAE with HCV has been mostly anecdotal; prevalence of NAE among HCV-infected patients has been reported to range between 0.2% and 1.7% [12,47]. Conversely, in the largest series of NAE patients described thus far (30 subjects), HCV infection was detected in 100% of cases [48]. Pathogenesis may be similar to that of psoriasis; data are indeed still scarce. Importantly, HCV eradication appears to ameliorate skin lesions [49]; alternatively, the disease may respond to topical and/or systemic steroids, thus reinforcing the hypothesis of a possible immune-mediated mechanism in NEA pathogenesis. There is scarce literature regarding DAA treatment of NAE in HCV-infected patients: one report described NAE resolution following treatment with ledipasvir, sofosbuvir, and ribavirin [50].