Common cutaneous manifestations of major liver diseases
DOI:
https://doi.org/10.59093/27112330.107Keywords:
skin manifestations, liver disease, cirrhosis, viral hepatitis, pruritus, jaundice, vasculitis.Abstract
Liver disease present multiple systemic manifestations, among which skin findings stand out, being the most common pruritus and jaundice. Other findings can also be manifested like spider angiomas, palmar erythema, xanthomas, vasculitis and changes in skin appendages. The objective of this article is to describe the main skin signs and symptoms of liver diseases to provide semiological tools to the physician in his daily practice.
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Godara SK, Thappa DM, Pottakkatt B, Hamide A, Barath J, Munisamy M, et al. Cutaneous manifestations in disorders of hepatobiliary system. Indian Dermatol Online J 2017;8:9-15. https://doi.org/10.4103/2229-5178.198760.
Satapathy SK, Bernstein D. Dermatologic disorders and the liver. Clin Liver Dis 2011;15:165-182. https://doi.org/10.1016/j.cld.2010.09.001.
Liu Y, Zhao Y, Gao X, Liu J, Ji F, Hsu YC, et al. Recognizing skin conditions in patients with cirrhosis: a narrative review. Ann Med 2022;54:3017-3029. https://doi.org/10.1080/07853890.2022.2138961.
Bhandari A, Mahajan R. Skin changes in cirrhosis. J Clin Exp Hepatol 2022;12:1215-1224. https://doi.org/10.1016/j.jceh.2021.12.013.
Koulaouzidis, A., Bhat, S., Moschos J. Skin manifestations of liver diseases. Ann Hepatol 2007;6:181-184. https://doi.org/10.1016/S1665-2681(19)31926-X.
Dogra S, Jindal R. Cutaneous manifestations of common liver diseases. J Clin Exp Hepatol 2011;1:177-184. https://doi.org/10.1016/s0973-6883(11)60235-1.
Sullivan JI, Rockey DC. Diagnosis and evaluation of hyperbilirubinemia. Curr Opin Gastroenterol 2017;33:164-170. https://doi.org/10.1097/mog.0000000000000354.
Joseph A, Samant H. Jaundice. Treasure Island (FL): StatPearls Publishing; 2023. Acceso 22 de junio de 2023. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK544252/.
Voltarelli VA, Alves de Souza RW, Miyauchi K, Hauser CJ, Otterbein LE. Heme: The lord of the iron ring. Antioxidants (Basel) 2023;12:1074. https://doi.org/10.3390/antiox12051074.
Fargo MV, Grogan SP, Saguil A. Evaluation of jaundice in adults. Am Fam Physician 2017;95:164-168.
Mondragón-Bustos D. Ictericia. Rev Med Sinerg 2016;1:14-18.
Pavlovic-Markovic A, Stojkovic-Lalosevic M, Mijac DD, Milovanovic T, Dragasevic S, Sokic-Milutinovic A, et al. Jaundice as a diagnostic and therapeutic problem: A general practitioner's approach. Dig Dis 2022;40:362-369. https://doi.org/10.1159/000517301.
Gondal B, Aronsohn A. A systematic approach to patients with jaundice. Semin Intervent Radiol 2016;33:253-258. https://doi.org/10.1055/s-0036-1592331.
Chen HL, Wu SH, Hsu SH, Liou BY, Chen HL, Chang MH. Jaundice revisited: recent advances in the diagnosis and treatment of inherited cholestatic liver diseases. J Biomed Sci 2018;25:75. https://doi.org/10.1186/s12929-018-0475-8.
Selim R, Ahn J. Pruritus in chronic liver disease. Clin Liver Dis 2023;27:47-55. https://doi.org/10.1016/j.cld.2022.08.011.
Misery L. Prurito. EMC-Dermatología 2018;52:1-10. https://doi.org/10.1016/S1761-2896(18)41446-X.
Beuers U, Wolters F, Oude Elferink RPJ. Mechanisms of pruritus in cholestasis: understanding and treating the itch. Nat Rev Gastroenterol Hepatol 2023;20:26-36. https://doi.org/10.1038/s41575-022-00687-7.
Terán Á, Fábrega E, Pons-Romero F. Prurito asociado a colestasis. Gastroenterol Hepatol 2010;33:313-322. https://doi.org/10.1016/j.gastrohep.2009.07.006.
Patel AD, Katz K, Gordon KB. Cutaneous manifestations of chronic liver disease. Clin Liver Dis 2020;24:351-360. https://doi.org/10.1016/j.cld.2020.04.003.
Hegade VS, Kendrick SF, Jones DE. Drug treatment of pruritus in liver diseases. Clin Med (Lond) 2015;15:351-357. https://doi.org/10.7861/clinmedicine.15-4-351.
Nautiyal A, Chopra KB. Liver palms (palmar erythema). Am J Med 2010;123:596-597. https://doi.org/10.1016/j.amjmed.2009.09.025.
Serrao R, Zirwas M, English JC. Palmar erythema. Am J Clin Dermatol 2007;8:347-356. https://doi.org/10.2165/00128071-200708060-00004.
Nadeem M, Muhammad-Abubakar Y, Zakaria M, Tasawar H, Nadir A. The value of clinical signs in diagnosis of cirrhosis. Pak J Med Sci 2005;21:121-124.
James WD, Elston DM, Treat JR, Rosenbach MA. Dermal and subcutaneous tumors. In: Neuhaus MA, ed. Andrews’ Diseases of the Skin: Elsevier inc; 2020. p. 587-635.
Terp K, Izquierdo-Pretel G. Spider angioma number and location as potential prognostic indicators in chronic liver disease: A case report. Cureus 2023;15:e34193. https://doi.org/10.7759/cureus.34193.
Patterson JW. Cutaneous infiltrates-Nonlymphoid. Weedon’s Skin Pathology. fifth ed. Amsterdam: Elsevier; 2021. p. 1181-1223.
Massengale WT. Xantomas. In: Callen JP, Cowen EW, Hruza GJ, Jorizzo JL, Lui H, Requena L, et al., eds. Dermatología: Elsevier; 2018. p. 1634-1643.
Zak A, Zeman M, Slaby A, Vecka M. Xanthomas: Clinical and pathophysiological relations. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014;158:181-188. https://doi.org/10.5507/bp.2014.016.
Wang CR, Tsai HW. Human hepatitis viruses-associated cutaneous and systemic vasculitis. World J Gastroenterol 2021;27:19-36. https://doi.org/10.3748/wjg.v27.i1.19.
Vergani D, Mieli-Vergani G. Autoimmune manifestations in viral hepatitis. Semin Immunopathol 2013;35:73-85. https://doi.org/10.1007/s00281-012-0328-6.
Cacoub P, Comarmond C, Domont F, Savey L, Saadoun D. Cryoglobulinemia vasculitis. Am J Med 2015;128:950-955. https://doi.org/10.1016/j.amjmed.2015.02.017.
Mazzaro C, Dal Maso L, Mauro E, Visentini M, Tonizzo M, Gattei V, et al. Hepatitis C virus- related cryoglobulinemic vasculitis: A review of the role of the new direct antiviral agents (DAAs) therapy. Autoimmun Rev 2020;19:102589. https://doi.org/10.1016/j.autrev.2020.102589.
Fernández-Chico N, Ribera-Pibernat M. Crioglobulinemia. Piel 2011;26:130-135. https://doi.org/10.1016/j.piel.2010.11.010.
Arango A, Velásquez-Franco CJ. Crioglobulinemias. Rev Colomb Reumatol 2012;19:40-51.
Hernández-Rodríguez J, Alba MA, Prieto-González S, Cid MC. Diagnosis and classification of polyarteritis nodosa. J Autoimmun 2014;48-49:84-89. https://doi.org/10.1016/j.jaut.2014.01.029.
Hočevar A, Tomšič M, Perdan Pirkmajer K. Clinical approach to diagnosis and therapy of polyarteritis nodosa. Curr Rheumatol Rep 2021;23:14. https://doi.org/10.1007/s11926-021-00983-2.
Springer JM, Byram K. Polyarteritis nodosa: an evolving primary systemic vasculitis. Postgrad Med 2023;135:61-68. https://doi.org/10.1080/00325481.2022.2088940.
Venzor J, Lee WL, Huston DP. Urticarial vasculitis. Clin Rev Allergy Immunol 2002;23:201-216. https://doi.org/10.1385/criai:23:2:201.
Kolkhir P, Pereverzina N, Olisova O, Maurer M. Comorbidity of viral hepatitis and chronic spontaneous urticaria: A systematic review. Allergy 2018;73:1946-1953. https://doi.org/https://doi.org/10.1111/all.13482.
Fitzpatrick JE, High WA, Kyle WL. Chapter 5-Urticarial and indurated eruptions. In: Fitzpatrick JE, High WA, Kyle WL, eds. Urgent Care Dermatology: Symptom-Based Diagnosis: Elsevier; 2018. p. 63-82. https://doi.org/10.1016/B978-0-323-48553-1.00005-7.
Palacios CP, Londoño Á, Restrepo R, Pinto LF, Velásquez CJ, Gómez LI, et al. Estudio descriptivo de urticaria vasculítica en Medellín, Colombia: características clínicas, epidemiológicas y de laboratorio. Rev Asoc Colomb Dermatol Cir Dematol 2013;21:135-144. https://doi.org/10.29176/2590843X.259.
Sack JS, Liu AF, Gray M, Roat J, Zucker SD. Association of terry nails with liver cirrhosis. Am J Gastroenterol 2021;116:2455-2458. https://doi.org/10.14309/ajg.0000000000001492.
Khichar S, Choudhary S. Terry nails in a patient with chronic alcoholic liver disease. Cleve Clin J Med 2014;81:603-604. https://doi.org/10.3949/ccjm.81a.13134.
Terry R. White nails in hepatic cirrhosis. Lancet 1954;266:757-759. https://doi.org/10.1016/s0140-6736(54)92717-8.
Witkowska AB, Jasterzbski TJ, Schwartz RA. Terry's nails: A sign of systemic disease. Indian J Dermatol 2017;62:309-311. https://doi.org/10.4103/ijd.IJD_98_17.
Albuquerque A, Sarmento J, Macedo G. Hepatobiliary and Pancreatic: Terry's nails and liver disease. J Gastroenterol Hepatol 2012;27:1539-1539. https://doi.org/https://doi.org/10.1111/j.1440-1746.2012.07184.x.
Nia AM, Ederer S, Dahlem KM, Gassanov N, Er F. Terry's nails: a window to systemic diseases. Am J Med 2011;124:602-604. https://doi.org/10.1016/j.amjmed.2010.11.033.
Tavares NT, Costa A, Damasceno M. Muehrcke's lines. Autops Case Rep 2018;8:e2018014. https://doi.org/10.4322/acr.2018.014.
Ramachandran V, Sapra A. Muehrcke lines of the fingernails, StatPearls. Treasure Island (FL): StatPearls Publishing; 2023. Acceso 15 de julio de 2023. Disponible en https://www.ncbi.nlm.nih.gov/books/NBK559136/.
Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol 2010;24:649-654. https://doi.org/10.1111/j.1468-3083.2009.03476.x.
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