Generalized Exfoliative Dermatitis and Liver Function

Abstract

SUMMARY 1. A group of seven different liver function tests was performed in ten cases of generalized exfoliative dermatitis of three weeks' to seven years' duration, and in ten controls suffering from various other skin ailments. In most of the cases the tests were repeated at intervals. In some of the test methods (cephalin flocculation, thymol turbidity, alkaline phosphatase, Schlesinger's urine test, serum globulin and albumin/globulin ratio), abnormal readings were found three times as often in cases of the disease as in the controls, but this was not found to be of statistical significance. Two other test methods showed a considerable lowering of the serum albumin level and of the hippuric acid excretion in the ten cases reviewed, as compared with the controls. These findings are of statistical significance. 2. Eesults of the series of liver function tests revealed that in cases of generalized exfoliative dermatitis the serum albumin levels and the hippuric acid excretion readings rose, as the exfoliation and the general state of the patient improved, and fell, as the patient's skin condition deteriorated. 3. Experimentally, by giving or withholding AOTH or cortisone, exfoliation could be stopped or started at will, and it was found that the serum albumin and hippuric acid excretion tests would follow the previously described pattern. 4. Eesults in the first group of test methods likewise varied with the deterioration and improvement of the skin condition, as estimated by the amount of exfoliation, but were not reliable. 5. Post‐mortem examination of the liver in one patient with generalized exfoliative dermatitis showed liver damage. Liver biopsy and post‐mortem examination in a further case showed abnormal histological changes in the liver. In both these cases, only the serum albumin levels and the hippuric acid excretion tests showed gross abnormal readings. There is suggestive evidence that the hippuric acid excretion test and the serum albumin level may be particularly affected in this condition. 6. Four patients in this series had enlarged livers at some time during their exfoliative phase (two of them prior to exfoliation), compared with one patient of the controls. 7. An impression was gained that generalized exfoliative dermatitis, which lasts more than three weeks, may produce a certain degree of liver damage, which is reversible after the skin condition has cleared and evidence is brought forward to support this hypothesis. 8. It is suggested that ACTH or cortisone may be of use in an attempt to determine in other disease processes, as in this series, which organ is primarily diseased in cases where various organs are affected.