Dermatological manifestations of liver cirrhosis: review of the literature

Authors

DOI:

https://doi.org/10.59093/27112330.99

Keywords:

hepatic cirrhosis, skin diseases, liver, skin, vascular system injuries, jaundice, pruritus.

Abstract

The skin and its annexes have a broad relationship with all organs and systems. Changes present in these can be the initial finding in a patient with liver disease, occurring in up to 20% of cases, therefore the extrahepatic manifestations become important, and although many of these are not specific, some dermatological markers can help in the diagnosis of the disease and may correlate with its severity. The development of cutaneous lesions in patients with liver cirrhosis is mainly generated by portal hypertension and excess of circulating estrogens, therefore their treatment is based on managing the underlying liver pathology. This article reviews the literature and describes a wide range of dermatological manifestations associated with liver cirrhosis, with their characteristics and etiopathogenesis, being the most frequent jaundice, pruritus, spider nevus, palmar erythema, caput Medusae veins, nail and hair changes, among others.

Downloads

Download data is not yet available.

Author Biographies

Jhon Edwar Garcia-Rueda, Hospital Pablo Tobón Uribe

Médico General, Hospital Pablo Tobón Uribe, Departamento de Hospitalización. Medellín, Colombia.

Laura Jaramillo-Santacoloma, Hospital Pablo Tobón Uribe

Médica General, Hospital Pablo Tobón Uribe, Departamento de Hospitalización. Medellín, Colombia.

Karen Yohana García-Rueda, Corporación Universitaria Remington

Estudiante de Medicina, Corporación Universitaria Remington. Medellín, Colombia.

Angélica María Bermúdez-Flórez, Universidad de Antioquia

Médica General, Universidad de Antioquia. Medellín, Colombia.

Jorge Alejandro Pamplona-Tobón, Hospital Pablo Tobón Uribe

Médico General, Hospital Pablo Tobón Uribe, Departamento de Hospitalización. Medellín, Colombia.

References

Trefts E, Gannon M, Wasserman DH. The liver. Curr Biol 2017;27:R1147-r1151. https://doi.org/10.1016/j.cub.2017.09.019.

Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician 2006;74:756-762.

Luján-Ramos MA, Díaz-Ramírez GS, Martínez-Casas OY, Morales-Ortiz AF, Donado-Gómez JH, Restrepo-Gutiérrez JC, et al. Caracterización de pacientes con cirrosis hepática y bacteriemia de un hospital universitario en Medellín, Colombia. Rev Colomb Gastroenterol 2020;35:455-464. https://doi.org/10.22516/25007440.557.

Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet 2021;398:1359-1376. https://doi.org/10.1016/s0140-6736(21)01374-x.

Espinoza-Herrera YP, Molina-Vélez V, Restrepo-Gutiérrez JC. Manifestaciones dermatológicas de las enfermedades hepáticas: un enfoque para el médico general. Med Lab 2012;18:229-238.

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.

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.

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.

Ghosn SH, Kibbi AG. Cutaneous manifestations of liver diseases. Clin Dermatol 2008;26:274-282. https://doi.org/10.1016/j.clindermatol.2008.02.001.

Hazin R, Abu-Rajab Tamimi TI, Abuzetun JY, Zein NN. Recognizing and treating cutaneous signs of liver disease. Cleve Clin J Med 2009;76:599-606. https://doi.org/10.3949/ccjm.76A.08113.

Ali MA. Spider nevi secondary to alcoholic chronic liver disease. Cleve Clin J Med 2022;89:301-302. https://doi.org/10.3949/ccjm.89a.21064.

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.

Li CP, Lee FY, Hwang SJ, Lu RH, Lee WP, Chao Y, et al. Spider angiomas in patients with liver cirrhosis: role of vascular endothelial growth factor and basic fibroblast growth factor. World J Gastroenterol 2003;9:2832-2835. https://doi.org/10.3748/wjg.v9.i12.2832.

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.

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.

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.

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.

Akiyama M, Inamoto N. Arteriovenous haemangioma in chronic liver disease: clinical and histopathological features of four cases. Br J Dermatol 2001;144:604-609. https://doi.org/10.1046/j.1365-2133.2001.04094.x.

Arnáiz-García ME, Arnáiz-García AM, Alonso-Peña D, García-Martín A, González-Santos JM, Arnáiz J. Puntos de Campbell de Morgan, hemangioma capilar o angioma senil. Med Gener Fam 2016;5:107-109. https://doi.org/10.1016/j.mgyf.2016.01.005.

Sharma B, Raina S. Caput medusae. Indian J Med Res 2015;141:494. https://doi.org/10.4103/0971-5916.159322.

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.

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/.

Fargo MV, Grogan SP, Saguil A. Evaluation of jaundice in adults. Am Fam Physician 2017;95:164-168.

Misery L. Prurito. EMC-Dermatología 2018;52:1-10. https://doi.org/10.1016/S1761-2896(18)41446-X.

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.

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.

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.

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.

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.

Chacon AH, Morrison B, Hu S. Acquired hemochromatosis with pronounced pigment deposition of the upper eyelids. J Clin Aesthet Dermatol 2013;6:44-46.

Saenz-de Santa María ML. Manifestaciones cutáneas de las enfermedades sistémicas. Rev Med Clin Condes 2011;22:749-756. https://doi.org/10.1016/S0716-8640(11)70487-4.

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/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.

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/.

Tavares NT, Costa A, Damasceno M. Muehrcke's lines. Autops Case Rep 2018;8:e2018014. https://doi.org/10.4322/acr.2018.014.

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.

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.

Assis DN. Chronic complications of cholestasis: Evaluation and management. Clin Liver Dis 2018;22:533-544. https://doi.org/10.1016/j.cld.2018.03.014.

Jerosch-Herold C, Shepstone L, Chojnowski AJ, Larson D. Splinting after contracture release for Dupuytren's contracture (SCoRD): protocol of a pragmatic, multi-centre, randomized controlled trial. BMC Musculoskelet Disord 2008;9:62. https://doi.org/10.1186/1471-2474-9-62.

Bertrand J, Thomas J, Metman EH. [Dupuytren's contracture and palmar erythema in alcoholic cirrhosis]. Sem Hop 1977;53:407-412.

Noble J, Arafa M, Royle SG, McGeorge G, Crank S. The association between alcohol, hepatic pathology and Dupuytren's disease. J Hand Surg Br 1992;17:71-74. https://doi.org/10.1016/0266-7681(92)90015-t.

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;141:367e-379e. https://doi.org/10.1097/prs.0000000000004120.

Townley WA, Baker R, Sheppard N, Grobbelaar AO. Dupuytren's contracture unfolded. BMJ 2006;332:397-400. https://doi.org/10.1136/bmj.332.7538.397.

Sato T. [Cutaneous manifestations of liver cirrhosis]. Nihon Rinsho 1994;52:170-173.

Maskey R, Karki P, Ahmed SV, Manandhar DN. Clinical profile of patients with cirrhosis of liver in a tertiary care hospital, Dharan, Nepal. Nepal Med Coll J 2011;13:115-118.

Vaishnav B, Tambile R, Minna K, Addepalli S, Wadivkar A, Pailla R, et al. Study of gonadal hormones in males with liver cirrhosis and its correlation with Child-Turcotte-Pugh and model for End-stage liver disease scores. Cureus 2023;15:e34035. https://doi.org/10.7759/cureus.34035.

Park BS, Moon SE, Kim JA. Disseminated superficial porokeratosis in a patient with chronic liver disease. J Dermatol 1997;24:485-487. https://doi.org/10.1111/j.1346-8138.1997.tb02826.x.

Published

2024-01-02

How to Cite

Garcia-Rueda, J. E., Jaramillo-Santacoloma, L., García-Rueda, K. Y., Bermúdez-Flórez, A. M., & Pamplona-Tobón, J. A. (2024). Dermatological manifestations of liver cirrhosis: review of the literature. Hepatología, 5(1), 13–24. https://doi.org/10.59093/27112330.99

Issue

Section

Review articles
QR Code
Crossref Cited-by logo