From the Guidelines
Skin rashes can occur with both hepatitis B and hepatitis C infections, though they're more common with hepatitis B. In hepatitis B, about 15-20% of patients develop a rash as part of a "serum sickness-like syndrome" during the acute phase, appearing as flat or raised red spots, hives, or itchy patches. These rashes typically resolve as the infection progresses. Hepatitis C less commonly causes skin manifestations directly, but can lead to conditions like lichen planus, porphyria cutanea tarda, or cryoglobulinemia which produce distinctive rashes, as seen in a study published in the Journal of Hepatology in 2020 1. The skin symptoms occur because these viral infections trigger immune responses that can affect blood vessels and skin tissues. Additionally, some medications used to treat these infections, particularly interferon-based therapies for hepatitis C, may cause rashes as side effects.
Some key points to consider:
- Hepatitis B is associated with a "serum sickness-like syndrome" that can cause a rash in about 15-20% of patients during the acute phase 1.
- Hepatitis C can lead to conditions like lichen planus, which is an inflammatory disorder involving the skin and the oro-genital mucous membranes, as described in a study published in Autoimmunity Reviews in 2017 1.
- Cryoglobulinemia, a condition associated with hepatitis C, can cause a systemic vasculitis that affects multiple organs, including the skin, and can be treated with direct-acting antivirals (DAAs) or rituximab, an anti-CD20 monoclonal antibody, as seen in a study published in the Journal of Hepatology in 2020 1.
- If you develop a rash while having hepatitis B or C, it's essential to consult your healthcare provider as it could be related to the infection, a medication side effect, or an unrelated condition requiring specific treatment.
In terms of treatment, the use of direct-acting antivirals (DAAs) has been shown to be effective in treating hepatitis C-related extrahepatic manifestations, including skin manifestations, with a study published in the Journal of Hepatology in 2020 showing an SVR rate of 87% in patients with cryoglobulin-associated vasculitis 1. Additionally, rituximab, an anti-CD20 monoclonal antibody, has been used to treat skin and organ involvement in patients with cryoglobulinemia associated with hepatitis C.
From the FDA Drug Label
Skin and subcutaneous tissue disorders: Alopecia, rash. The answer is yes, skin rash can occur with hepatitis B.
- Hepatitis B treatment with entecavir may cause skin rash as a side effect, as reported in the postmarketing experience 2.
- Hepatitis treatment with tenofovir may also cause rash, as reported in HIV-infected adult subjects and HBV-infected subjects with decompensated liver disease 3. No direct information about hepatitis C is available in the provided drug labels.
From the Research
Hepatitis B and Skin Rash
- Hepatitis B infection can cause several extrahepatic cutaneous manifestations, including serum sickness-like syndrome and polyarteritis nodosa 4, 5.
- Serum sickness-like syndrome is the most common cutaneous manifestation associated with HBV infection, and it can present with symptoms such as rash, arthritis, and headache 5, 6.
- Papular acrodermatitis of childhood (Gianotti-Crosti Syndrome) is a rare cutaneous manifestation of HBV infection in children, characterized by non-pruritic, non-coalescing, round papules 5.
Hepatitis C and Skin Rash
- Hepatitis C infection is associated with several cutaneous manifestations, including mixed cryoglobulinemia, porphyria cutanea tarda, and lichen planus 4, 5, 7.
- Porphyria cutanea tarda is a cutaneous manifestation of HCV infection, characterized by typical cutaneous lesions, chronic liver disease, and moderate iron overload 7.
- Mixed cryoglobulinemia is a common extrahepatic manifestation of HCV infection, and it can cause symptoms such as rash, arthritis, and kidney disease 4, 5.
Urticaria and Hepatitis
- Acute urticaria is a common symptom of hepatitis A and B infection, and it can also occur in hepatitis C infection, although rare cases have been published 6.
- Chronic urticaria is not typically associated with hepatitis B or C infection, and routine screening for these infections in patients with chronic urticaria is not recommended unless liver function tests are abnormal or risk factors are present 6, 8.