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Hepatitis C and Porphyria Cutanea Tarda

Nicole Cutler L.Ac. July 24, 2013

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If Porphyria Cutanea Tarda (PCT) is an extrahepatic manifestation of your Hepatitis C infection, you are not alone. Make sure you know about the ways people with Hep C typically manage with this incurable skin condition.

Hepatitis C is a viral infection of the liver. However, this disease commonly causes extrahepatic manifestations – problems that go beyond the liver. Believed to be 12 times more likely to affect Americans with Hepatitis C compared with the general population, Porphyria Cutanea Tarda (PCT) is a skin disease that does not yet have a cure. Even though there is no way to eliminate PCT, those affected can find solace by knowing about the effective ways one can manage this skin condition.

Understanding Porphyria Cutanea Tarda

Caused by an excess of porphyrins in the blood, porphyria defines a group of diseases. Some of the substances involved in porphyria are described below:

  • Porphyrins are complex molecules that combine with iron to produce heme.
  • Heme is responsible for giving blood its red color.
  • Heme combines with globin to form hemoglobin.
  • Hemoglobin is a protein in red blood cells that carries oxygen.

One of the most common types of porphyria, PCT is triggered by a deficiency of an enzyme called uroporphyrinogen decarboxylase (UROD). With less UROD, excessive amounts of a certain protein (uroporphyrinogen) accumulate in the blood and urine. Too much uroporphyrinogen results in an abnormal production of heme.

While PCT is most frequently caused by Hepatitis C infection, it can also be caused or triggered by the following:

  • Hemochromatosis (accumulation of iron in the liver)
  • Heavy alcohol use
  • Estrogen therapy (oral contraceptives, prostate cancer treatment)
  • Other viral infections (like HIV)
  • Smoking
  • A genetic deficiency of UROD

PCT Symptoms

Although PCT is due to a problem in the production of blood, its symptoms are mostly confined to the skin. In general, there are four recognizable symptoms of PCT:

  1. Blisters – The most common symptom of PCT is blistering that occurs after exposure to the sun. Painful blisters usually appear on the face, hands and arms as these areas tend to be more exposed. Resulting blisters crust over and take longer than normal to heal, causing scabs and scars.
  2. Easily Injured Skin – Those with PCT have delicate skin that is prone to injury, regardless of sun exposure. Bruises form easily and light scratches or burns last longer than expected, and typically leave scars.
  3. Skin Pigmentation – Becoming either very light or very dark, pigmentation changes commonly occur with PCT.
  4. Abnormal Hair Growth – Loss of hair on the scalp and increased growth of facial hair is common in both men and women with PCT. Although this abnormal pattern of hair growth can be seen in other illnesses, it is very common with in those with PCT.

PCT Management

Despite its lack of a cure, PCT is considered to be one of the easiest porphyrias to manage. Most experts agree that this Hepatitis C extrahepatic manifestation can be managed well by combining the following approaches:

  • Phlebotomy – Phlebotomy is the removal of blood from the body – and it ends up reducing iron levels in the liver. By reducing iron, porphyrins can return to normal levels.
  • Sun Protection – Porphyrins absorb radiant energy most efficiently at very long ultraviolet and visible light wavelengths. Thus, those with PCT are advised to avoid the sun when possible, and use sunscreen and protective clothing (gloves, hats, pants and long-sleeved shirts) when outside.
  • Anti-Malaria Drugs – Low doses of chloroquine or hydroxychloroquine can remove excess porphyrins from the liver. However, doses that are too high cause porphyrins to be removed too rapidly, resulting in a temporary worsening of PCT and damage to the liver.
  • Iron Awareness – Foods containing iron are usually not a significant aggravator of PCT, but iron-containing dietary supplements should definitely be avoided. In addition, adequate amounts of dietary Vitamin C should be consumed because it helps the body absorb iron.
  • Avoid Triggers – Alcohol is known to be a PCT trigger. Besides alcohol’s ability to exponentially worsen Hepatitis C infection and cause liver damage, it can aggravate PCT. In addition, smoking cigarettes or voluntarily taking an estrogen containing substance (like birth control pills) can bring on a PCT episode.
  • Antiviral Treatment – By treating Hepatitis C with interferon plus ribavirin therapy, those with PCT often experience a decrease in skin lesions.

Despite being relatively uncommon, PCT is more likely to occur in those with Hepatitis C. For those with Porphyria Cutanea Tarda, there is not yet a way to increase UROD enzyme production. However, there are a handful of approaches those with Hepatitis C can use to manage this skin condition – including several that can be accomplished without a physician’s prescription.

References:

http://emedicine.medscape.com/article/1103643-followup, Porphyria Cutanea Tarda: Follow-up, Maureen B Poh-Fitzpatrick, MD, Retrieved October 24, 2009, Medscape, 2009.

http://www.corrections.com/news/article/22321-hepatitis-c-associated-skin-conditions, Hepatitis C Associated Skin Conditions, Retrieved October 23, 2009, The Corrections Connection, October 2009.

http://www.ehow.com/about_5054874_symptoms-porphyria-cutanea-tarda.html, The Symptoms of Porphyria Cutanea Tarda, Trisha Bartle, Retrieved October 24, 2009, eHow Inc., 2009.

http://www.hcvadvocate.org/hepatitis/factsheets_pdf/PCT.pdf, Extrahepatic Manifestations: Porphyria Cutanea Tarda (PCT), Alan Franciscus, Retrieved October 24, 2009, Hepatitis C Support Project, December 2007.

http://www.springerlink.com/content/pu32t71306276763/, Management of hepatitis C virus in patients with porphyria cutanea tarda, Peter W. M. Dienhart and Richard K. Sterling, Retrieved October 24, 2009, Current Hepatitis Reports, August 2005.

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