Russian Journal of Skin and Venereal DiseasesRussian Journal of Skin and Venereal DiseasesРоссийский журнал кожных и венерических болезней1560-95882412-9097Eco-Vector11229210.17816/dv112292DERMATOLOGYДЕРМАТОЛОГИЯResearch ArticleUrticarial vasculitis in patients with chronic hepatitis C virus as an interdisciplinary problemУртикарный васкулит у пациентов с хроническим вирусным гепатитом С как междисциплинарная проблемаhttps://orcid.org/0000-0002-0428-56275983-9344TeplyakovaKseniya S.ТепляковаКсения Сергеевна
Russian Federation

Graduate Student

аспирант

hvpvea@gmail.comI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)290120231712202225655700211202220122022Copyright ©; 2022, Teplyakova K.S.Copyright ©; 2022, Теплякова К.С.2022Teplyakova K.S.Теплякова К.С.https://creativecommons.org/licenses/by-nc-nd/4.0/https://rjsvd.com/1560-9588/article/view/112292

Urticarial vasculitis is a skin disease characterized by recurrent urticarial lesions and histological features of leukocytoclastic vasculitis. Urticarial vasculitis is known to occur in the association with various infectious diseases, including chronic hepatitis C virus. However, the clinical features of urticarial vasculitis associated with hepatitis C virus have not been systematically characterized, which complicates the management of these patients.

This review presents an analysis of published clinical, histological and laboratory findings in patients with urticarial vasculitis in the association with chronic hepatitis C virus, which can be helpful for early diagnosis and optimization of the patient management.

We performed a Pubmed search to identify clinical cases from 1971 to 2022 using the keywords "urticarial vasculitis", "hepatitis C virus infection". According to the inclusion/exclusion criteria, 13 clinical cases of urticarial vasculitis associated with hepatitis C virus were included in the analysis.

Clinical manifestations were urticarial rashes (n=13), associated with residual hyperpigmentation in 8 patients, tenderness/burning ― in 7 patients, and a lesion duration (>24 hours) ― in five patients. Arthralgias were described in 3 patients.

On histological examination, there were fibrinoid necrosis (n=2); leukocytoclasia (n=4); erythrocyte extravasation (n=1); dermis edema (n=2); perivascular infiltrate consisting of neutrophils (n=5), eosinophils (n=4), lymphocytes (n=3), and histiocytes (n=2). Hypocomplementemia was reported in eight patients. The laboratory work revealed cryoglobulinemia (n=9) and positive rheumatoid factor (n=6), which were the characteristic findings in the association of these diseases.

The association of urticarial vasculitis and chronic hepatitis C virus is an important interdisciplinary problem that requires an interaction of dermatologists, allergists, hepatologists, rheumatologists and infectious disease doctors. Histological examination is indicated to differentiate between urticaria and urticarial vasculitis in patients with atypical urticarial lesions. Early detection of chronic hepatitis C virus is necessary for the timely administration of antiviral therapy. The urticarial vasculitis treatment should be selected taking into account their efficacy and the risk of hepatotoxicity.

Уртикарный васкулит ― заболевание кожи, клинически характеризующееся рецидивирующими уртикарными высыпаниями и гистологически имеющее признаки лейкоцитокластического васкулита. Известны ассоциации уртикарного васкулита с различными инфекциями, в том числе с хроническим вирусным гепатитом С. Однако клинические особенности уртикарного васкулита и хронического вирусного гепатита С изучены недостаточно, что значительно затрудняет выбор тактики ведения таких пациентов.

В данном обзоре представлен анализ опубликованных клинических, гистологических и лабораторных данных пациентов с уртикарным васкулитом в ассоциации с хроническим вирусным гепатитом С для ранней диагностики и оптимизации ведения пациентов.

В базе данных PubMed был проведён поиск клинических случаев уртикарного васкулита за период с 1971 по 2022 г. с использованием ключевых слов «urticarial vasculitis», «hepatitis С virus infection». По критериям включения/исключения в обзор были включены и проанализированы 13 клинических случаев уртикарного васкулита, ассоциированного с хроническим вирусным гепатитом С.

Клиническими особенностями являлись уртикарные высыпания (n=13) в сочетании с резидуальными явлениями у 8 больных, с болезненностью/жжением ― у 7. У 5 пациентов уртикарные высыпания существовали более 24 ч. Артралгии отмечены в 3 случаях. Важными гистологическими особенностями были фибриноидный некроз (n=2); лейкоцитоклазия (n=4); экстравазация эритроцитов (n=1); отёк сосудов и дермы (n=2); периваскулярный инфильтрат, состоящий из нейтрофилов (n=5), эозинофилов (n=4), лимфоцитов (n=3) и гистиоцитов (n=2). У 8 пациентов выявлена гипокомплементемия. При обследовании пациентов выявлены криоглобулинемия (n=9) и положительный ревматоидный фактор (n=6), что является характерной особенностью при сочетании данных заболеваний.

Сочетание уртикарного васкулита с хроническим вирусным гепатитом С является важной междисциплинарной проблемой, требующей взаимодействия дерматологов, аллергологов, гепатологов, ревматологов и врачей-инфекционистов. Раннее выявление хронического вирусного гепатита С необходимо для своевременного назначения противовирусной терапии. Выбор препаратов для лечения уртикарного васкулита следует проводить с учётом их клинической эффективности и риска гепатотоксичности.

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