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

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. (J Am Acad Dermatol 2009;61:1044-55.)