Can a history of hepatitis C and treatment with Epclusa (sofosbuvir/velpatasvir) cause erythematous hands and a burning sensation?

Erythematous and Burning Hands After Hepatitis C and Epclusa Treatment

Erythematous and burning hands are not a typical side effect of Epclusa (sofosbuvir/velpatasvir) treatment for hepatitis C, but may represent a rare cutaneous adverse reaction that should be evaluated by a dermatologist.

Epclusa and Skin Reactions

Epclusa (sofosbuvir/velpatasvir) is generally well-tolerated with a favorable safety profile compared to older hepatitis C treatments. According to the FDA label and clinical guidelines:

• The most common adverse reactions with Epclusa are fatigue, headache, nausea, and asthenia 1
• Rash is reported in only 2% of patients treated with Epclusa in clinical trials, and these were typically mild to moderate in severity 1
• The European Association for the Study of the Liver (EASL) guidelines note that sofosbuvir/velpatasvir has a low rate of treatment discontinuation due to adverse events (<1%) 2

Potential Causes of Erythematous and Burning Hands

1. Direct-Acting Antiviral (DAA) Reactions

• While uncommon, DAAs like Epclusa can occasionally cause dermatological reactions
• The EASL guidelines do not specifically list erythematous hands or burning sensations as known side effects of sofosbuvir/velpatasvir 2
• Case reports have documented rare instances of hand-foot syndrome with interferon-free hepatitis C therapy, though this is more commonly associated with ribavirin combinations 3

2. Post-Treatment Manifestations

• Symptoms appearing after successful HCV treatment may represent:
  • Immune reconstitution after viral clearance
  • Delayed hypersensitivity reaction
  • Unmasking of another condition previously suppressed by chronic HCV infection

3. Alternative Explanations

• Erythematous and burning hands could be related to:
  • Pre-existing dermatological conditions exacerbated during treatment
  • Mixed cryoglobulinemia (HCV-related immune complex disease) that can persist after treatment 2
  • Unrelated dermatological conditions coinciding with HCV treatment

Evaluation and Management

1. Dermatological Assessment

   • A skin examination should classify the severity of the reaction (Grade 1-3) 2
   • Consider skin biopsy if the diagnosis is unclear or symptoms are severe

2. Treatment Approach

   • For mild to moderate symptoms:

     • Topical corticosteroids for inflammation
     • Oral antihistamines for pruritus
     • Moisturizers for xerosis (dry skin)

   • For more severe symptoms:

     • Oral corticosteroids may be necessary
     • Consider dermatology referral
     • Monitor for signs of secondary infection 3

3. Monitoring

   • Follow up to ensure resolution of symptoms
   • Document the reaction for future reference if additional HCV treatment is needed

Important Considerations

• Patients with a history of drug reactions may be more susceptible to skin reactions during HCV treatment 3
• The presence of these symptoms does not necessarily indicate treatment failure - sustained virological response can still be achieved despite adverse effects 3
• If symptoms developed after completing treatment, they may resolve spontaneously over time

Conclusion

While erythematous and burning hands are not commonly reported with Epclusa treatment, they could represent a rare cutaneous adverse reaction. These symptoms should be evaluated by a healthcare provider to determine appropriate management and to rule out other potential causes.