Treatment of psoriasis in patients with hepatitis C: From the Medical Board of the National Psoriasis Foundation

published online 08 October 2009.

Background

Treating psoriasis in patients with concomitant hepatitis C virus (HCV) infection presents a special challenge. Not only is psoriasis exacerbated by interferon therapy, the standard of care for HCV, but many psoriasis therapies are potentially hepatotoxic, immunosuppressive, or both, which has been generally thought to be a contraindication in chronic infections such as HCV.

Objective

Our aim was to arrive at a consensus on treating psoriasis in patients with concomitant HCV infection.

Methods

Reports in the literature were reviewed regarding common psoriasis therapies and liver toxicity.

Results

Topical therapies are first-line therapy for patients with limited psoriasis and HCV. Ultraviolet B phototherapy may be considered as a second-line treatment when needed. Ultraviolet B phototherapies in combination with topical therapies are first line for patients with moderate to severe psoriasis, and are considered safe in those patients with concomitant HCV infection. Other systemic therapies, such as acitretin, etanercept, and, possibly, other tumor necrosis factor inhibitors, are considered second line. Psoralen plus ultraviolet A should also be considered a second-line therapy.

Limitations

There are few evidence-based studies on treating psoriasis with systemic therapy in patients with pre-existing liver disease.

Conclusions

There are no large double-blind clinical trials addressing the treatment of psoriasis in patients with HCV infection and more studies are needed.

Key words: hepatitis C, phototherapy, psoriasis, systemic therapy, topical therapy

Abbreviations used: FDA, Food and Drug Administration, HCV, hepatitis C virus, MMF, mycophenolate mofetil, PsA, psoriatic arthritis, PUVA, psoralen plus ultraviolet A, TNF, tumor necrosis factor, UV, ultraviolet

a Department of Dermatology, Tufts Medical Center, Boston, Massachusetts

b Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania

c Department of Dermatology, Baylor College of Medicine, Houston, Texas

d Department of Dermatology and the Murdough Family Center for Psoriasis, Case Western Reserve University/University Hospital of Cleveland, Cleveland, Ohio

e Department of Dermatology, Mount Sinai School of Medicine, New York University, New York, New York

f National Psoriasis Foundation, Portland, Oregon

Reprint requests: Alice B. Gottlieb, MD, PhD, Department of Dermatology, Tufts Medical Center, 800 Washington St, Tufts-NEMC #114, Boston, MA 02111.

Funding sources: None.

Disclosure: Dr Van Voorhees has served as a consultant/speaker/advisor for Amgen, Abbott, Biogen, Centocor, Genentech, Incyte, Warner Chilcott, Connetics, VGX, and Xtrac. She has been an investigator for Amgen, Astellas, Genentech, Warner Chilcott, Roche, Bristol Myers Squibb, and IDEC. She has served on a drug safety monitoring board for Synta. She also is a stockholder and owns stock options in Merck. Dr Hsu has been a consultant for Abbott, Amgen, Biogen Idec, Centocor, and Genentech. She has been a clinical investigator for Amgen and Centocor. Dr Korman has been a consultant, investigator, or speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Lebwohl has been a consultant for Abbott, Amgen, Astellas, Centocor, Genentech, UCB Pharma, Stiefel, Triax, Pharmaderm, Medicis, Novartis, and Warner Chilcott. He has been a speaker for Abbott, Amgen, Astellas, Centocor, and Genentech. Dr Bebo is employed by the National Psoriasis Foundation. The Foundation receives unrestricted financial support from Abbott, Centocor, Amgen, Wyeth, Genentech, Astellas, Stiefel, Galderma, Warner Chilcott, and Photomedix. Almost all of Dr Gottlieb's consulting and speaking fees are paid to Tufts Medical Center. Dr Gottlieb is a member of the speakers bureau of Amgen Inc and Wyeth Pharmaceuticals; has current consulting/advisory board agreements with Amgen Inc, Centocor Inc, Wyeth Pharmaceuticals, Celgene Corp, Bristol Myers Squibb Co, Beiersdorf Inc, Warner Chilcott, Abbott, Roche, Sankyo, Medarex, Kemia, Celera, TEVA, Actelion, UCB, Novo Nordisk, Almirall, Immune Control, RxClinical, Dermipsor Ltd, Medacorp, DermiPsor, Can-Fite, Incyte, Corgentech, Magen Biosciences, Stieffel, and Puretech; Tufts Medical Center has received research/educational grants from Centocor Inc, Amgen Inc, Wyeth Pharmaceuticals, Immune Control, Celgene Corp, Pharmacare, Incyte, and Abbott. Dr Frankel has no conflicts of interest to declare.

PII: S0190-9622(09)00396-X

doi:10.1016/j.jaad.2009.03.044

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