Sustained improvement of psoriasis associated with HCV after virologic response to sofosbuvir/ribavirin

An 18 year old boy attended a dermatology clinic outside our hospital and diagnosed with psoriasis. His skin lesions over both ankles (Fig. 1) did not improve at all with potent local steroids twice for 3 months, then 3 times daily for another 3 months. His dermatologist talked to him about using methotrexate and asked for liver function tests before starting the systemic therapy. His ALT and AST were doubled. The patient came to our Hepatology clinic worried about his elevated liver enzymes. We asked for viral markers. His HCV-Ab was positive, and PCR for HCV-RNA was 650,000 IU/ml. Treatment started with sofosbuvir 400 mg PO once daily plus ribavirin 600 mg at the morning and 400 mg at the evening. After 4 weeks, ALT and AST decreased to normal and PCR for HCV-RNA was <5 IU/ml. All other lab tests were unremarkable. The skin lesions improved markedly (Fig. 2). Now, after 6 months of the end of treatment, sustained virologic response was documented and the skin lesions are almost disappeared without any topical or systemic treatment.