Cyclosporine as Monotherapy for Psoriasis in the Setting of Chronic HCV Infection: A Forgotten Therapeutical Option

authors:

avatar Alexandra Maria Giovanna Brunasso 1 , * , avatar Paolo Michetti 2 , avatar Laura Fancelli 3 , avatar Cesare Massone 4

1) Department of Dermatology, Galliera Hospital, Genoa, Italy. 2) Department of Environmental Dermatology and Venereology, Medical University of Graz, giovanna.brunasso@gmail.com, Austria
Department of Gastroenterology, Galliera Hospital, Italy
Department of Dermatology, Medical University of Florence, Italy
Department of Dermatology, Medical University of Graz, Austria
Hepatitis Monthly: Vol.12, issue 5; 349-352
article type: Case Report
received: April 20, 2011
accepted: May 12, 2012
DOI: https://doi.org/10.5812/hepatmon.6057

how to cite: Giovanna Brunasso A, Michetti P, Fancelli L, Massone C. Cyclosporine as Monotherapy for Psoriasis in the Setting of Chronic HCV Infection: A Forgotten Therapeutical Option. Hepat Mon. 2012;12(5): 349-352. https://doi.org/10.5812/hepatmon.6057.

Abstract

Background: Treatment of psoriasis in the setting of chronic hepatitis C virus (HCV) infection is diffcult, because standard therapies like methotrexate are associated with increased hepatic toxicity. Due to the HCV suppressive effect. Cyclosporine may represent a valid systemic alternative for psoriatic-HCV patients.
Objectives: In this study, we report the successful usage of intermittent cycles of cyclosporine in the setting of chronic HCV infection and we try to call the attention once again in a very effective and forgotten therapeutic option for severe chronic plaque psoriasis.
Observation: We describe a 48 years - old patient who has a 20 year history of severe chronic plaque psoriasis and HCV infection (aminotransferase levels are three times normal; HCV genotype 2a-2c and HCV-RNA titer of 2.050.000 UI-ml). Five courses (range of duration of three to six months) of oral cyclosporine (5 mg/kg/day) were followed during a 38 month period. The viral load and the transaminases’ levels diminished during the 38 months of intermittent cyclosporine therapy to the lowest level measured at 36th month. The good psoriatic response was associated to a slight improvement of the liver condition, even though the HCV-RNA was reduced by less than 1 log10 without normalization of aminotransferase’ levels.
Conclusions: The reduced liver toxicity, the potential anti-HCV properties and the well-known systemic anti-in?ammatory effect, make cyclosporine a good alternative for recalcitrant psoriatic patients with HCV-liver disease.

Implication for health policy/practice/research/medical education:
Cyclosporine can be considered a valid option for treatment of severe psoriasis in the setting of chronic HCV infection.
Please cite this paper as:
Giovanna Brunasso AM, Michetti P, Fancelli L, Massone C. Cyclosporine as Monotherapy for Psoriasis in the Setting of Chronic HCV Infection: A Forgotten Therapeutical Option. Hepat Mon. 2012;12(5): 349-52. DOI: 10.5812/hepatmon.6057

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