Recognizing and treating cutaneous signs of liver disease

Abstract

Cutaneous changes may be the first clue that a patient has liver disease. Recognizing these signs is crucial to diagnosing liver conditions early. Here we describe the spectrum of skin manifestations that may be found in various liver diseases.

Appearances in clinical dermatology

“…The name comes from the resemblance the thread-like capillaries have to the finely chopped silk threads in American dollar bills. [71] Peau d'orange appearance A descriptive term for any bosselated, rugose surface, usually of the skin with deep, pin-point dimpling, likened by French authors to the skin of an orange; the 'classic' peau d'orange change occurs in skin overlying breast cancer with involvement of the underlying lymphatics. [72] In dermatologic diseases it can be seen in lesions of mastocytoma.…”

Manifestações dermatológicas em uma casuística de doença hepática crônica de um hospital de referência em Belém, Estado do Pará, Brasil

“…Outro estigma de doença hepática com fisiopatogenia semelhante, encontrado em um paciente deste estudo, é o eritema palmar, decorrente de vasodilatação cutânea restrita à região palmar, principalmente nas regiões tenar e hipotenar. Embora mais comuns em pacientes com cirrose, essas lesões podem ocorrer em várias outras doenças do fígado 32,33 .…”

“…A doença hepática é uma condição muito comum no âmbito da medicina interna e pode estar associada a várias manifestações extra-hepáticas envolvendo os rins, ossos, sistema nervoso, trato gastrointestinal e a pele 1 . Alterações cutâneas podem ser o primeiro indício de que um paciente tem uma doença que acomete o fígado.…”

The Skin and Viral Liver Disease

“…In this respect, it can incidentally be considered that since 2005 all Italian dermatologists involved in the management of psoriasis with 'biologic' and 'nonbiologic' systemic agents have to mandatorily adhere to the well-established pharmacovigilance roadmap dictated by the so-called 'Psocare' program. 1 Moreover, another independent aim-oriented dermatology registry network, the Psonet (http://www.psonet.eu) [129,147], has more recently branched off from the Psocare program in order to merge data and strategy protocols from most European countries, along with Israel and Australia. Properly surveyed administration of anti-TNFα agents in HBV patients has been reported to be an overall safe treatment option in the setting of both noncutaneous inflammatory conditions [148,149] as well as psoriasis [136,150,151].…”

“…A recent review of the issue by Hazin and coworkers [1] is introduced by the following simple but just as brilliant statement: "Dysfunction in the body's second largest organ, the liver, often yields changes in the body's largest organ, the skin". The most trivial paradigm sustaining such an obvious assumption is jaundice when it is sustained by primary failure of hepatocytes to perform one of their main functions, that is to conjugate bilirubin into a secretable form.…”