Cyclosporine as monotherapy for psoriasis in the setting of chronic HCV infection: A forgotten therapeutical option

Abstract

Background: 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. 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 therapeutically 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 upright 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. Conclusion: The reduced liver toxicity, the potential anti-HCV properties and the wellknown systemic anti-inflammatory effect, make cyclosporine a good alternative for recalcitrant psoriatic patients with HCV-liver disease. © 2012 Kowsar Corp. All rights reserved.