skin manifestation liver disease

2. 1.PIGMENTARY CHANGES
2.VASCULAR CHANGES
3.COAGULATION DEFECTS
4.PRURITIS
5.NAILCHANGES
CUTANEOUS MANIFESTATIONS OF HEPATIC DISEASES

3. PIGMENTARY CHANGES
 JAUNDICE/ICTERUS:
 generalized yellowish coloration of the
skin and mucosae
 serum bilirubin levels greater than 2.5–
3.0 mg/dL
 HYPERMELANOSIS
 diffuse hyperpigmentation – long
standing cirrhosis
 over exposed sites or palmoplantar
creases, or in a perioral and periorbital
distribution

4. VASCULAR CHANGES
 SPIDER ANGIOMA (NEVUS ARANEUS,
SPIDER NEVUS)
 Seen in chronic liver disease
 central arteriole visible as a red, flat or slightly
elevated point surrounded by multiple, small,
and tortuous radiating capillaries
 Pinhead-sized to up to 2 cm in diameter
 Blanchable lesions
 Larger lesions may pulsate
 lesions are commoner in alcoholic cirrhosis
 presence may indicate an increased risk of
bleeding from esophageal varices in such
patients

5.  PALMAR ERYTHEMA/ LIVER PALMS:
 Exaggerated mottling or a well defined hypothenar
erythema that later spreads to fingers and rest of the palm.
 UNILATERAL NEVOID TELENGIECTASIA:
 Fine thread like telengiectasia present mostly over C3,
C4 dermatome

6.  PAPER MONEY SKIN
 Presence of numerous threadlike
small blood vessels scattered
randomly throughout the skin
 CAPUT MEDUSAE
 dialated & radiating veins seen
around the umblicus due to portal
hypertension

7. COAGULATION DEFECTS
• Bruising, petechiae, purpura, and ecchymosis.
• Mucosal bleeding (epistaxis or gingival bleeding).

8. PRURITUS
• Mostly seen in cholestasis
• presenting complaint in more than half of the patients
of primary biliary cirrhosis
• Itch is usually more pronounced on the extremities,
although the trunk may be equally affected and
multiple excoriations may be found.
• Due to- Retained cutaneous bile acids. The
endogenous opioid system also play a major role
• Severe pruritus in primary biliary cirrhosis may be
accompanied by a diffuse hyperpigmentation, often
sparing a “butterfly” area on the upper back

9. Treatment:
• Bile acid sequestrants like cholestyramine
drugs relieving cholestasis like ursodeoxycholic acid
• Opiod antagonists – Naltrexone
Naloxone
Nalmefene
• Sedating antihistaminics
• Phototherapy
• Hepatic enzyme inducers (rifampicin, phenobarbital.)

10. NAIL CHANGES
- Clubbing
- Longitudinal ridging
- Thickening
- Brittleness
- Total leuconychia
• Terry’s nails
(whitening of the entire nail plate
except for a narrow pink band distally)
•Muehrcke’s nails
(multiple parallel
transverse white bands)

11. PRIMARY BILIARY
CIRRHOSIS
1.Jaundice & pruritis
2.CREST syndrome - Reynolds’
syndrome
3.Xanthomas - yellowish
plaques covering large areas of
skin in palmar creases
(xanthoma striatum palmare)
and in scars

12. Hepatitis B infection
Urticaria
serum sickness-like picture
 resulting from the deposition of circulating immune
complexes
Angioedema, erythema nodosum, or erythema multiforme
may also be associated
Gianotti–Crosti syndrome
 papular acrodermatitis.
 Multiple, monomorphic, erythematous papules occurring on
the acral areas and the face are characteristic of this
condition.
 Skin lesions typically last at least 10 days.
 GCS is thought to be a hypersensitive response to the
underlying infection.

13. Hepatitis C
 Mixed cryoglobulinemia
 Due to chronic stimulation of the immune system by HCV.
 Characterized by the presence of cryoglobulins in the blood.
Cryoglobulins are abnormal proteins that thicken and clump
together at cold temperature
 resulting in palpable purpura, livedo reticularis,
acrocyanosis, urticated plaques, hemorrhagic bullae, or
ulcers.
 Interferon alfa (IFN-α) can improve skin, kidney, and/or joint
involvement, and may be the drug of choice for HCV-related
cryoglobulinemia

14.  porphyria cutanea tarda
 painful, blistering skin lesions that develop on sun-exposed skin
(photosensitivity). Affected skin is fragile and may peel or blister after minor
trauma
 Pathogenesis - oxidative stresses due to intracellular glutathione depletion,
elevation of hepatic iron levels, and reduced activity of hepatic
uroporphyrinogen decarboxylase due to autoantibodies

15.  NECROLYTIC ACRAL ERYTHEMA
•occur almost exclusively in individuals with HCV infection
•Starts as erythematous papules that coalesce into
well-circumscribed dusky areas with scaling and erosions.
•Older lesions- hyperkeratotic surface.
• Mc site- dorsal surface of feet-great toes.
• Periorificial areas are not involved
• Zinc deficiency play a role in the pathogenesis
 RED FINGERS SYNDROME
• HCV-associated dermatosis.
• It is characterized by well defined telangiectatic erythema of
the fingers and toes

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