Giovanna Brunasso Alexandra Maria, Michetti Paolo, Fancelli Laura, Massone Cesare
Department of Dermatology, Galliera Hospital, Genoa, Italy.
Hepat Mon. 2012 May;12(5):349-52. doi: 10.5812/hepatmon.6057. Epub 2012 May 30.
Treatment of psoriasis in the setting of chronic hepatitis C virus (HCV) infection is difficult, 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.
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.
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.
The reduced liver toxicity, the potential anti-HCV properties and the well-known systemic anti-inflammatory effect, make cyclosporine a good alternative for recalcitrant psoriatic patients with HCV-liver disease.
在慢性丙型肝炎病毒（HCV）感染的情况下治疗银屑病很困难，因为甲氨蝶呤等标准疗法会增加肝脏毒性。由于HCV抑制作用，环孢素可能是银屑病合并HCV患者有效的全身治疗选择。
在本研究中，我们报告了环孢素间歇疗程在慢性HCV感染患者中的成功应用，并再次呼吁关注这一针对重度慢性斑块状银屑病的非常有效却被遗忘的治疗选择。
我们描述了一名48岁患者，有20年重度慢性斑块状银屑病和HCV感染病史（转氨酶水平是正常的三倍；HCV基因型2a - 2c，HCV - RNA滴度为2,050,000 UI/ml）。在38个月期间进行了五个疗程（持续时间为三到六个月）的口服环孢素（5 mg/kg/天）治疗。在38个月的环孢素间歇治疗期间，病毒载量和转氨酶水平降至第36个月时测量的最低水平。银屑病病情的良好改善与肝脏状况的轻微改善相关，尽管HCV - RNA降低了不到1 log10，转氨酶水平未恢复正常。
肝脏毒性降低、潜在的抗HCV特性以及众所周知的全身抗炎作用，使环孢素成为患有HCV肝病的顽固性银屑病患者的良好替代治疗药物。
