How to Identify and Treat a Hepatitis Rash

Hepatitis C disease is an infection and inflammation of the liver due to the hepatitis C virus. The virus is transmitted from person to person through the blood, and people typically get the virus by sharing needles.

More than half of the people with the virus develop chronic hepatitis C liver disease. Chronic hepatitis C can lead to several health problems, but the illness is primarily associated with cirrhosis (scarring of the liver) and liver cancer. 

One of the common problems people with hepatitis C develop is a debilitating rash. There are several different rashes associated with the infection. Sometimes, it can be challenging to know whether a rash is related to hepatitis C or something else.

This article will discuss the types of rashes associated with hepatitis C and their appearance. It will also explore the symptoms, treatment, and prevention of hepatitis C and associated rashes.

Person itching a rash that could be due to hepatitis

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What Does a Hepatitis Rash Look Like?

Acute and chronic infection with hepatitis C leads to liver damage and can also cause other health problems called extrahepatic manifestations of chronic hepatitis C infection. Extrahepatic means apart from the liver. People with hepatitis C can develop blood, immune system, kidney, and skin problems.

Hepatitis C Statistics

The Centers for Disease Control and Prevention (CDC) estimates that 2.4 million people were living with hepatitis C in 2013–2016.

Most people with hepatitis C will develop an extrahepatic problem, and these symptoms often involve the skin.

Several rashes are associated with hepatitis C infection, so describing an isolated hepatitis C rash is difficult. People with hepatitis C can develop:

  • Blisters
  • Vesicles and bullae (very large blisters)
  • Urticaria (also known as hives)
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Purple macules and papules (spots and lumps on the skin)
  • Psoriasis-like skin lesions (purple or silver plaques with scaling)

Hepatitis Rash Causes

A rash from hepatitis C can occur during all phases of the illness, including acute infection, chronic disease, severe liver damage, and while receiving treatment.

Acute Hepatitis C

One of the earliest symptoms of acute hepatitis C infection is jaundice. It develops when the liver is damaged and unable to break down bilirubin, a waste product produced when red blood cells are destroyed because they are old or abnormal.

Jaundice is a typical skin problem with nearly all forms of severe hepatitis. People with jaundice often also have:

  • Dark urine 
  • Pale stools
  • Itching

Chronic Hepatitis C

Several rashes may be seen in chronic hepatitis C.

Porphyria Cutanea Tarda

Porphyria cutanea tarda is strongly linked to hepatitis C, particularly in southern Europe. The rash appears as chronic skin blistering associated with sun sensitivity and easy skin damage. Minor trauma can lead to redness, vesicles, and large blisters.

Although this rash is highly linked to hepatitis C, it is rare overall. The rash typically improves with treatment for chronic hepatitis C infection.

Lichen Planus

Lichen planus can develop in several disease states. However, people with lichen planus often have liver disease and are likely to have underlying hepatitis C infection as the cause of the liver disease.

The rash appears as a flat-topped, violet, itchy rash that can be found anywhere on the body, including the scalp and inside the mouth. This rash is found more often during the later stages of liver disease.

Necrolytic Acral Erythema

Necrolytic acral erythema is another itchy rash associated with hepatitis C infection. It looks like psoriasis. This means the lesions are very distinct and red to purple, with a scaly appearance. Over time the lesions grow more prominent. They are often located on the legs.

Necrolytic acral erythema is a rare skin rash. It may improve by treating hepatitis C virus infection.

Leukocytoclastic vasculitis

Leukocytoclastic vasculitis is a hepatitis C complication involving the skin and causing joint pain, kidney disease, and neurological problems. The rash shows up as purple spots on the skin that can be very small (called petechiae). The rash can improve by treating hepatitis C infection.

Urticaria

People with chronic hepatitis infections, including hepatitis B and hepatitis C, can develop urticaria or hives. An urticarial rash is where a person has itchy red swellings. The same type of rash is often associated with an allergic reaction. It can develop in people with hepatitis, but it is not that common.

How Common Is Urticaria in Hepatitis C?

Less than 3% of people with hepatitis C have an urticaria rash.

Severe Liver Disease and Damage

People with chronic hepatitis C slowly develop worsening liver damage if the disease is left untreated. Eventually, they develop cirrhosis (late-stage scarring of the liver). The loss of liver function contributes to other skin conditions, including:

  • Spider nevi, the appearance of tiny blood vessels near the skin surface
  • Scratch marks from chronic itching

Early Hepatitis C Symptoms

Hepatitis C is typically transmitted through exposure to infected blood, which usually occurs through sharing needles. Many people with a new hepatitis C viral infection do not have any symptoms. When symptoms do occur, they can include:

  • Fever
  • Fatigue
  • Jaundice
  • Dark urine
  • Abdominal pain
  • Nausea and vomiting
  • Joint pain

These symptoms usually begin about two to 12 weeks after exposure to the virus.

Treatment

Treatment of hepatitis C infection revolves around antiviral therapy. These medications have been found to cure the infection. They are recommended for all people with chronic hepatitis C. However, the medicines can be costly and difficult to access.

There are several antiviral regimens available. The specific regimen needed for an individual depends on the virus genetics and the severity of the liver disease.

Treating Hepatitis C Treats a Hepatitis Rash

Treating hepatitis C is often the only thing needed to clear up a rash associated with hepatitis C.

Previously, people were treated with interferon and another antiviral called ribavirin. The treatment combination has significant side effects, including skin rashes.

Therefore, newer agents called direct-acting antivirals are recommended. These newer agents are very well tolerated and have fewer side effects. Speaking with a healthcare provider to determine which therapies are best for you is essential.

Prevention

Unlike hepatitis A and hepatitis B infections, no vaccine is available to prevent hepatitis C. A person usually can avoid exposure to hepatitis C by avoiding blood exposure, especially through needlesticks.

Injection drug use is the most common way to contract hepatitis C in the United States, so the best way to avoid the infection is to use clean needles or stop using injection drugs.

Summary

Hepatitis C can lead to severe problems outside of cirrhosis and liver cancer. Most people with hepatitis C develop debilitating rashes. The different skin manifestations include jaundice, porphyria cutanea tarda, lichen planus, necrolytic acral erythema, leukocytoclastic vasculitis, and urticaria.

The best way to relieve a hepatitis C rash is by treating the hepatitis C viral infection. However, even antiviral therapies can lead to a rash. It is best to speak to a healthcare provider about a rash related to hepatitis C. Preventing infection with hepatitis C is ideal mostly by avoiding exposure to blood, especially due to shared needles. 

A Word From Verywell

Hepatitis C is a severe infection that leads to severe liver damage and liver cancer. Debilitating rashes are often associated with chronic hepatitis C. However, healthcare providers can treat these skin problems by treating hepatitis C. Speak with a healthcare provider about your treatment options.

Frequently Asked Questions

  • What does a hepatitis rash indicate?

    Certain skin problems can mean that a person has an undiagnosed hepatitis C infection. However, not everyone with hepatitis C develops symptoms, and some rashes are not always associated with hepatitis C. It is important to speak with a healthcare provider about a chronic rash.

  • How common are hepatitis rashes?

    Approximately 75% of people with hepatitis C will develop a hepatitis C-related rash during their infection.

  • When should I be worried about a hepatitis rash?

    It's always best speak to a healthcare provider about your chronic rash to determine the severity. Concerning signs of a rash include:

    • Rapid spread
    • Significant blistering
    • Signs of infection such as redness, warmth, and drainage
    • Darkening of the skin
    • Associated symptoms such as trouble breathing or fever
  • Will a hepatitis rash go away on its own?

    Most rashes associated with hepatitis C will resolve by treating the underlying hepatitis C infection. A rash from hepatitis C generally will not resolve on its own without seeking some treatment for the rash or the underlying disease process.

12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Christine Zink, MD
Dr. Christine Zink, MD, is a board-certified emergency medicine with expertise in the wilderness and global medicine. She completed her medical training at Weill Cornell Medical College and residency in emergency medicine at New York-Presbyterian Hospital. She utilizes 15-years of clinical experience in her medical writing.