title: Low dose ribavirin has been effective in the treatment of incapacitating muco-cutaneous extrahepatic manifestations in patients with hepatitis C with contraindication or no access for approved antiviral treatment.
abstract: OBJECTIVE
  Chronic hepatitis C virus (HCV) is a major public health problem and represents a common cause of chronic liver disease worldwide. The Egyptian Demographic Health Survey (EDHS) has estimated HCV prevalence in Egypt to be 14.7%. HCV can affect multiple organ systems and cause a variety of extrahepatic manifestations. Most of extrahepatic manifestations affect the skin and mucous membranes; such as lichen planus (LP), psoriasis, and leucocytoclastic vasculitis. The treatment of extrahepatic manifestations has been disappointing in patients not indicated for interferon with no access for the new costly all oral treatments.
  
  
  METHODS
  In 2014, thirty Egyptian patients with incapacitating mucocutaneous extrahepatic manifestations due to chronic HCV infection, not indicated for interferon, have been randomised into two groups; group I treated with ribavirin (5-10mg/kg daily divided into 2 doses), and group II treated with local steroids for 3months. Patients were followed up for 3months. Dermatology life quality index score has been measured before and after treatment for all patients.
  
  
  RESULTS
  A significant improvement of mucocutaneous lesions has been accomplished in group I in comparison to group II (p<0.01). All lesions in group I showed a significant improvement except psoriasis (p>0.05). A significant improvement of dermatology life quality index score has been found in patients in group I when compared to group II (p<0.05).
  
  
  CONCLUSIONS
  We conclude that low dose ribavirin was effective in the treatment of incapacitating mucocutaneous extrahepatic manifestations of chronic HCV infection in patients with contraindication or no access to the approved antiviral treatments.
authors.affiliation: Department of Tropical Medicine and Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt.
authors.forename: Eslam Saber
authors.initials: ES
authors.lastname: Esmail
authors.affiliation: Department of Tropical Medicine and Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt.
authors.forename: Fat-heyah Elsayed
authors.initials: FH
authors.lastname: Asal
authors.affiliation: Department of Tropical Medicine and Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Yussif
authors.affiliation: Department of Tropical Medicine and Infectious Diseases, Tanta University Faculty of Medicine, Tanta, Egypt.
authors.forename: Asem Ahmed
authors.initials: AA
authors.lastname: Elfert
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006297:Health Services Accessibility; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008010:Lichen Planus / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy* / Q000209:etiology; D011788:Quality of Life; D012254:Ribavirin / Q000008:administration & dosage*; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin
keywords: Extrahepatic manifestations; HCV; Ribavirin