Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2020; 12(10): 841-849
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.841
Effect of treating chronic hepatitis C with direct-acting antivirals on extrahepatic cutaneous manifestations
Mohamed El Kassas, Osama MO Hegazy, Eman M Salah
Mohamed El Kassas, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Osama MO Hegazy, Eman M Salah, Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
Author contributions: El Kassas M and Salah EM conceptualized the idea and design; all authors participated in, and supervised the patients’ treatment and follow-up; Hegazy OMO drafted the manuscript; Salah EM revised and edited the manuscript; all authors revised and approved the final version of the manuscript.
Institutional review board statement: All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Research Ethics Committee (REC) for human subject research at the Faculty of Medicine, Helwan University (Serial: 1-2018) on 22 August 2018.
Informed consent statement: Informed consent was obtained from all participants included in the study.
Conflict-of-interest statement: Author Mohamed El Kassas is an advisory committee board member in AbbVie and shared in speaking & teaching activities for Roche, MSD, AbbVie, Eva, Mash Premier, Takeda, Organon, AUG, Inspire, HSO, received grants and research support from Gilead Sc., Intercept, Rameda, Ipsen, and Alfa Cure. Osama MO Hegazy and Eman Salah declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohamed El Kassas, MD, Associate Professor, Department of Endemic Medicine, Faculty of Medicine, Helwan University, Helwan, Cairo 11795, Egypt. m_elkassas@yahoo.com
Received: May 3, 2020
Peer-review started: May 3, 2020
First decision: May 24, 2020
Revised: May 25, 2020
Accepted: September 15, 2020
Article in press: September 15, 2020
Published online: October 27, 2020

Hepatitis C virus (HCV) is a disease with a significant global impact, affecting approximately 2%-2.5% of the world’s population. New direct-acting antivirals (DAAs) have been introduced over the past few years with great success in viral eradication. The association of chronic HCV infection with a wide spectrum of cutaneous manifestations has been widely reported in the literature.


To assess the effect of treating HCV with DAAs on the extrahepatic cutaneous manifestations of HCV.


This prospective observational study included 1039 HCV positive Egyptian patients who were eligible to receive DAAs. A total of 30 patients were diagnosed with extrahepatic cutaneous manifestations and fulfilled the inclusion criteria of the study. Of these patients, 6 had classic lichen planus, 8 were diagnosed with psoriasis vulgaris and 16 had pruritus. All patients received DAAs from October 2018 to July 2019 in the form of a three-month course of sofosbuvir/daclatasvir combination. Patients with lichen planus or psoriasis were dermoscopically evaluated before treatment and 6 mo after treatment, while patients with hepatic pruritus were assessed using the 12-Item Pruritus Severity Scale over the same period.


All patients with psoriasis showed significant improvement in all psoriatic plaques, and all patients with hepatic pruritus scored 0 on the 12-Item Pruritus Severity Scale indicating total improvement of pruritus. In addition, four of six patients with lichen planus showed complete improvement.


Treatment of HCV with DAAs was significantly effective in improving virus-related extrahepatic cutaneous manifestations.

Keywords: Directly acting antivirals, Extrahepatic manifestations, Hepatitis C virus, Lichen planus, Pruritus, Cutaneous manifestations

Core Tip: In this study, we investigated the impact of hepatitis C virus (HCV) clearance using direct-acting antivirals (DAAs) on the dermatological extrahepatic manifestations of HCV. To our knowledge, this is the largest cohort of patients with cutaneous manifestations of HCV to be treated in the literature (30 patients). In addition, we used dermoscopy for the first time in this study to better evaluate the response of cutaneous diseases to DAAs.