To investigate the effect and tolerability of sofosbuvir-based regimens for hepatitis C virus (HCV) associated cutaneous manifestations.

The effect and tolerability of sofosbuvir-based direct-acting antivirals (DAAs) regimens for 6 patients with HCV infection and cutaneous manifestations in the Second Affiliated Hospital of Xi’an Jiaotong University were analyzed, retrospectively. The sustained virologic response at 12 weeks after end-of-treatment (SVR12), changes liver function, remission of skin lesions and safety during and after treatment were evaluated, respectively.

The age of the 6 patients were 25-56 years old; including 5 female, 2 cases with cirrhosis, 3 cases with HCV genotype 1b and 3 cases with HCV genotype 2a. The cutaneous manifestations included eczema scrotum, prurigo nodosa, erythema nodosum, lichen planus, Sjogren’s syndrome and mixed cryoglobulinemia (MC)-associated rashes. Two patients were pathologically diagnosed as HCV-associated skin lesions, and 4 patients were clinically diagnosed. Patients received sofosbuvir/velpatasvir (3 cases) or sofosbuvir/ledipasvir (2 cases) for 12 weeks and sofosbuvir/ribavirin (1 case) for 24 weeks. There were significant reductions in serum alanine aminotransferase from baseline to the end-of-treatment and 12 weeks post-treatment, with slight increase or no change in serum albumin. All 6 patients achieved SVR12 and significant improvement of cutaneous manifestations. Three patients (eczema scrotum, prurigo nodosa and Sjogren’s syndrome) achieved completed remission of skin lesions, other skin lesions (erythema nodosum, lichen planus and MC-associated rashes) that significantly relieved, but required immunosuppressive and (or) cytotoxic to maintain therapy. No patient had experienced significant side-effects and recurrence of skin damage during the follow-up.

HCV could cause different extrahepatic skin manifestations, sofosbuvir-based regimens achieved high SVR12 rate, and alleviated the skin lesions. Screening for HCV should be performed in patients with cutaneous manifestations as soon as possible when the effect of symptomatic therapy was unsatisfactory.