Skip to main content
Top
Published in:

18-09-2024 | Liver and Bile Duct Disease | REVIEW Free for a limited time

Liver and Cutaneous Manifestations

Authors: Jitendra Dandotiya, S. R. Reethesh, Manav Wadhawan

Published in: Current Hepatology Reports | Issue 4/2024

Login to get access

Abstract

Purpose of Review

Cutaneous manifestations are quite common in liver diseases and are often considered non-specific as some of these manifestations are seen even in healthy individuals.It is the constellation of these changes which points towards underlying liver diseases. This review is meant to detail the cutaneous changes that underline the concerned liver disease & help us reach the diagnosis better.

Recent Findings

No relevant recent findings in this topic.

Summary

Cutaneous manifestations seen in the setting of liver cirrhosis includes icterus, pruritus, spider angiomas, palmar erythema, xanthomas, pigmentary changes, nutritional deficiencies and hair & nail changes. There are certain cutaneous manifestations which are specific for certain liver diseases like HBV infection, HCV infection, PBC etc. Early identification of these cutaneous manifestations is critical for early diagnosis and management and underscores the importance of a good general physical examination
Literature
1.
go back to reference Asif T, Mohiuddin A, Hasan B, Pauly RR. Importance Of Thorough Physical Examination: A Lost Art. Cureus. 2017;5:e1212. Asif T, Mohiuddin A, Hasan B, Pauly RR. Importance Of Thorough Physical Examination: A Lost Art. Cureus. 2017;5:e1212.
3.
go back to reference Li CP, Lee FY, Hwang SJ, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. Scand J Gastroenterol. 1999;34:520–3.CrossRefPubMed Li CP, Lee FY, Hwang SJ, et al. Spider angiomas in patients with liver cirrhosis: role of alcoholism and impaired liver function. Scand J Gastroenterol. 1999;34:520–3.CrossRefPubMed
4.
go back to reference Du AS, Yang J, Lu S. Zeng JZ [Facial skin lesions in male patients with liver cirrhosis: role of serum sex hormones and correlation with impaired liver function]. Zhonghua Gan Zang Bing Za Zhi. 2013;21:354–8.PubMed Du AS, Yang J, Lu S. Zeng JZ [Facial skin lesions in male patients with liver cirrhosis: role of serum sex hormones and correlation with impaired liver function]. Zhonghua Gan Zang Bing Za Zhi. 2013;21:354–8.PubMed
5.
go back to reference Pirovino M, Linder R, Boss C, Kochli HP, Mahler F. Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations. Klin Wochenschr. 1988;66:298–302.CrossRefPubMed Pirovino M, Linder R, Boss C, Kochli HP, Mahler F. Cutaneous spider nevi in liver cirrhosis: capillary microscopical and hormonal investigations. Klin Wochenschr. 1988;66:298–302.CrossRefPubMed
6.
go back to reference Li CP, Lee FY, Hwang SJ, et al. Spider angiomas in patients with liver cirrhosis: role of vascular endothelial growth factor and basic fibroblast growth factor. World J Gastroenterol. 2003;9:2832–5.CrossRefPubMedPubMedCentral Li CP, Lee FY, Hwang SJ, et al. Spider angiomas in patients with liver cirrhosis: role of vascular endothelial growth factor and basic fibroblast growth factor. World J Gastroenterol. 2003;9:2832–5.CrossRefPubMedPubMedCentral
7.
go back to reference Li CP, Lee FY, Hwang SJ, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol. 1999;94:502–7.CrossRefPubMed Li CP, Lee FY, Hwang SJ, et al. Role of substance P in the pathogenesis of spider angiomas in patients with nonalcoholic liver cirrhosis. Am J Gastroenterol. 1999;94:502–7.CrossRefPubMed
8.
go back to reference Witte CL, Hicks T, Renert W, Witte MH, Butler C. Vascular spider: a cutaneous manifestation of hyperdynamic blood flow in hepatic cirrhosis. South Med J. 1975;68:246–8.CrossRefPubMed Witte CL, Hicks T, Renert W, Witte MH, Butler C. Vascular spider: a cutaneous manifestation of hyperdynamic blood flow in hepatic cirrhosis. South Med J. 1975;68:246–8.CrossRefPubMed
10.
go back to reference Broekstra DC, Groen H, Molenkamp S, Werker PMN, van den Heuvel ER. A Systematic Review and Meta-Analysis on the Strength and Consistency of the Associations between Dupuytren Disease and Diabetes Mellitus, Liver Disease, and Epilepsy. Plast Reconstr Surg. 2018;141(3):367–79.CrossRefPubMedCentral Broekstra DC, Groen H, Molenkamp S, Werker PMN, van den Heuvel ER. A Systematic Review and Meta-Analysis on the Strength and Consistency of the Associations between Dupuytren Disease and Diabetes Mellitus, Liver Disease, and Epilepsy. Plast Reconstr Surg. 2018;141(3):367–79.CrossRefPubMedCentral
11.
go back to reference Hayashi N, George J, Takeuchi M, Fukumura A, Toshikuni N, Arisawa T, et al. Acetaldehyde-derived advanced glycation end-products promote alcoholic liver disease. PLoS ONE. 2013;8(7): e70034.CrossRefPubMedPubMedCentral Hayashi N, George J, Takeuchi M, Fukumura A, Toshikuni N, Arisawa T, et al. Acetaldehyde-derived advanced glycation end-products promote alcoholic liver disease. PLoS ONE. 2013;8(7): e70034.CrossRefPubMedPubMedCentral
12.
go back to reference Satoh T, Yokozeki H, Nishioka K. Vascular spiders and paper money skin improved by hemodialysis. Dermatol Basel Switz. 2002;205(1):73–4.CrossRef Satoh T, Yokozeki H, Nishioka K. Vascular spiders and paper money skin improved by hemodialysis. Dermatol Basel Switz. 2002;205(1):73–4.CrossRef
13.
go back to reference Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol JEADV. 2010;24(6):649–54.CrossRefPubMed Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol JEADV. 2010;24(6):649–54.CrossRefPubMed
14.
go back to reference Ramos-e-Silva M, Azevedo-e-Silva MC, Carneiro SC. Hair, nail, and pigment changes in major systemic disease. Clin Dermatol. 2008;1(26):296–305.CrossRef Ramos-e-Silva M, Azevedo-e-Silva MC, Carneiro SC. Hair, nail, and pigment changes in major systemic disease. Clin Dermatol. 2008;1(26):296–305.CrossRef
15.
go back to reference Abd El Meged MM. Patterns of nail changes in chronic liver diseases. Sohag Medical Journal. 2019;23(2):145–9.CrossRef Abd El Meged MM. Patterns of nail changes in chronic liver diseases. Sohag Medical Journal. 2019;23(2):145–9.CrossRef
16.
17.
go back to reference Smith KE, Fenske NA. Cutaneous manifestations of alcohol abuse. J Am Acad Dermatol. 2000;43(1 Pt 1):1–16 (quiz 16–8).CrossRefPubMed Smith KE, Fenske NA. Cutaneous manifestations of alcohol abuse. J Am Acad Dermatol. 2000;43(1 Pt 1):1–16 (quiz 16–8).CrossRefPubMed
18.
go back to reference Hazin R, AbuRajab Tamimi TI, Abuzetun JY, Zein NN. Recognizing and treating cutaneous signs of liver disease. Cleve Clin J Med. 2009;76: 599606.CrossRef Hazin R, AbuRajab Tamimi TI, Abuzetun JY, Zein NN. Recognizing and treating cutaneous signs of liver disease. Cleve Clin J Med. 2009;76: 599606.CrossRef
19.
go back to reference Amador A, Monforte NG, Bejarano N, et al. Cutaneous metastasis from hepatocellular carcinoma as the first clinical sign. J Hepatobiliary Pancreat Surg. 2007;14:328.CrossRefPubMed Amador A, Monforte NG, Bejarano N, et al. Cutaneous metastasis from hepatocellular carcinoma as the first clinical sign. J Hepatobiliary Pancreat Surg. 2007;14:328.CrossRefPubMed
20.
go back to reference Kee SJ, Kim TJ, Lee SJ, et al. Dermatomyositis associated with hepatitis B virus- related hepatocellular carcinoma. Rheumatol Int. 2009;29:595–9.CrossRefPubMed Kee SJ, Kim TJ, Lee SJ, et al. Dermatomyositis associated with hepatitis B virus- related hepatocellular carcinoma. Rheumatol Int. 2009;29:595–9.CrossRefPubMed
21.
go back to reference Shastry S, Rajesh R, Sangamesh S, Siddharth G. Hepatitis A: A refreshing perspective through a rare symptom in a teaching hospital in south India. J Fam Med Prim Care. 2020;9(7):3749–52.CrossRef Shastry S, Rajesh R, Sangamesh S, Siddharth G. Hepatitis A: A refreshing perspective through a rare symptom in a teaching hospital in south India. J Fam Med Prim Care. 2020;9(7):3749–52.CrossRef
22.
go back to reference Press J, Maslovitz S, Avinoach I. Cutaneous necrotizing vasculitis associated with hepatitis Avirus infection. J Rheumatol. 1997;24:965–7.PubMed Press J, Maslovitz S, Avinoach I. Cutaneous necrotizing vasculitis associated with hepatitis Avirus infection. J Rheumatol. 1997;24:965–7.PubMed
23.
go back to reference Segool RA, Lejtenyi C, Taussig LM. Articular and cutaneous prodromal manifestations of viral hepatitis. J Pediatr. 1975;87:709–12.CrossRefPubMed Segool RA, Lejtenyi C, Taussig LM. Articular and cutaneous prodromal manifestations of viral hepatitis. J Pediatr. 1975;87:709–12.CrossRefPubMed
24.
go back to reference Inman RD, Hodge M, Johnston ME, Wright J, Heathcote J. Arthritis, vasculitis, and cryoglobulinemia associated with relapsing hepatitis Avirus infection. Ann Intern Med. 1986;105:700–3.CrossRefPubMed Inman RD, Hodge M, Johnston ME, Wright J, Heathcote J. Arthritis, vasculitis, and cryoglobulinemia associated with relapsing hepatitis Avirus infection. Ann Intern Med. 1986;105:700–3.CrossRefPubMed
25.
go back to reference Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part II J Am Acad Dermatol. 1999;41:661–77.CrossRefPubMed Brown TJ, Yen-Moore A, Tyring SK. An overview of sexually transmitted diseases. Part II J Am Acad Dermatol. 1999;41:661–77.CrossRefPubMed
26.
go back to reference Jones AM, Warken K, Tyring SK. The cutaneous manifestations of viral hepatitis. Dermatol Clin. 2002;20:233–47 (vi).CrossRefPubMed Jones AM, Warken K, Tyring SK. The cutaneous manifestations of viral hepatitis. Dermatol Clin. 2002;20:233–47 (vi).CrossRefPubMed
27.
go back to reference Gocke DJ, Hsu K, Morgan C, Bombardieri S, Lockshin M, Christian CL. Association between polyarteritis and Australia antigen. Lancet. 1970;2:1149–53.CrossRefPubMed Gocke DJ, Hsu K, Morgan C, Bombardieri S, Lockshin M, Christian CL. Association between polyarteritis and Australia antigen. Lancet. 1970;2:1149–53.CrossRefPubMed
28.
go back to reference Guillevin L, Lhote F, Gherardi R. Polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: clinical aspects, neurologic manifestations, and treatment. Neurol Clin. 1997;15:865–86.CrossRefPubMed Guillevin L, Lhote F, Gherardi R. Polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: clinical aspects, neurologic manifestations, and treatment. Neurol Clin. 1997;15:865–86.CrossRefPubMed
29.
go back to reference Minkowitz G, Smoller BR, McNutt NS. Benign cutaneous polyarteritis nodosa. Relationship to systemic polyarteritis nodosa and to hepatitis B infection. Arch Dermatol. 1991;127:1520–3.CrossRefPubMed Minkowitz G, Smoller BR, McNutt NS. Benign cutaneous polyarteritis nodosa. Relationship to systemic polyarteritis nodosa and to hepatitis B infection. Arch Dermatol. 1991;127:1520–3.CrossRefPubMed
30.
31.
go back to reference Wiznia LE, Laird ME, Franks AG Jr. Hepatitis C virus and its cutaneous manifestations: treatment in the direct-acting antiviral era. J Eur Acad Dermatol Venereol. 2017;31(8):1260–70.CrossRefPubMed Wiznia LE, Laird ME, Franks AG Jr. Hepatitis C virus and its cutaneous manifestations: treatment in the direct-acting antiviral era. J Eur Acad Dermatol Venereol. 2017;31(8):1260–70.CrossRefPubMed
32.
go back to reference Túlio M, Carvalho L, Bana E Costa T, Chagas C, Chagas C. Mixed cryoglobulinemia: a diagnostic and therapeutic challenge. BMJ Case Rep. 2017;2017:10. Túlio M, Carvalho L, Bana E Costa T, Chagas C, Chagas C. Mixed cryoglobulinemia: a diagnostic and therapeutic challenge. BMJ Case Rep. 2017;2017:10.
33.
go back to reference Musset L, Diemert MC, Taibi F, Thi Huong DuL, Cacoub P, Leger JM, et al. Characterization of cryoglobulins by immunoblotting. Clin Chem. 1992;38:798–802.CrossRefPubMed Musset L, Diemert MC, Taibi F, Thi Huong DuL, Cacoub P, Leger JM, et al. Characterization of cryoglobulins by immunoblotting. Clin Chem. 1992;38:798–802.CrossRefPubMed
34.
go back to reference Sayiner M, Golabi P, Farhat F, Younossi ZM. Dermatologic Manifestations of Chronic Hepatitis C Infection. Clin Liver Dis. 2017;21:555–64.CrossRefPubMed Sayiner M, Golabi P, Farhat F, Younossi ZM. Dermatologic Manifestations of Chronic Hepatitis C Infection. Clin Liver Dis. 2017;21:555–64.CrossRefPubMed
35.
go back to reference Ward SK, Roenigk HH, Gordon KB. Dermatologic manifestations of gastrointestinal disorders. Gastroenterol Clin North Am. 1998;27:615–36.CrossRefPubMed Ward SK, Roenigk HH, Gordon KB. Dermatologic manifestations of gastrointestinal disorders. Gastroenterol Clin North Am. 1998;27:615–36.CrossRefPubMed
36.
go back to reference Johnston GA, Graham-Brown RAC. The skin and disorders of the alimentary tract, the hepatobiliary system, kidney, and cardiopulmonary system. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008. pp. 1445–60. Johnston GA, Graham-Brown RAC. The skin and disorders of the alimentary tract, the hepatobiliary system, kidney, and cardiopulmonary system. In: Wolff K, Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, editors. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008. pp. 1445–60.
37.
go back to reference Floreani A, Franceschet I, Cazzagon N, et al. Extrahepatic autoimmune conditions associated with primary biliary cirrhosis. Clin Rev Allergy Immunol. 2015;1(48):192–7.CrossRef Floreani A, Franceschet I, Cazzagon N, et al. Extrahepatic autoimmune conditions associated with primary biliary cirrhosis. Clin Rev Allergy Immunol. 2015;1(48):192–7.CrossRef
39.
go back to reference Spitz J. Genodermatosese: A Clinical Guide to Genetic Skin Disorders. 2nd ed. USA: Lippincott, Williams & Wilkins; 2005. Spitz J. Genodermatosese: A Clinical Guide to Genetic Skin Disorders. 2nd ed. USA: Lippincott, Williams & Wilkins; 2005.