Recognizing skin conditions in patients with cirrhosis: a narrative review

Abstract

Background: The skin is a major target organ for extrahepatic manifestations of liver diseases, and dermatologic abnormalities are common in patients with hepatic disorders. Clinical examination of the skin, nails and hair can allow for appropriate recognition, early diagnosis and treatment of liver diseases, and improvement in the quality of life and life expectancy of affected patients.Methods: We searched 3 databases (Pubmed,Medline and Embase) and selected studies about cirrhosis related skin manifestations and their pathophysiology.Results: A total of 73 articles were included in the review. Studies displayed the spectrum of cutaneous manifestations related to hormonal and vascular changes as well as nail and hair changes in patients with cirrhosis and/or portal hypertension.Conclusion: Cutaneous alterations are important clues or potential indications in the diagnosis of liver cirrhosis. Familiarity with skin conditions can be promptly diagnosed and appropriate management initiated.KEY MESSAGESManifestations of the liver and skin disorders are interrelated in various ways. Cutaneous changes may be the first clue that a patient has liver disease.The skin is a major target organ for extrahepatic manifestations of liver diseases. A broad range of cutaneous alterations can be present in patients with cirrhosis, such as vascular, nail, hair, hormonal changes, etc.Recognizing these signs is crucial so that potential underlying diseases including liver disease can be promptly diagnosed and appropriate management timely initiated.

Keywords: Liver cirrhosis; Terry’s nails; nail diseases; palmar erythema; skin manifestations; spider angioma.

Figure 1.

Vascular alterations in patients with chronic liver disease. (a) Palmar erythema, (b, c) Spider angioma, (d) Arteriovenous haemangioma, (e, f) arteriovenous haemangioma on the upper lip of a 38-year-old cirrhotic male with HBV infection, with remission after 10 years of antiviral treatment. (g) Paper money skin, (h) caput medusa, (i) abdominal varicose veins in inferior vena cava obstruction syndrome.

Figure 2.

Nail changes in patients with chronic liver disease. (a–c) Terry’s nails, (d) Lindsay’s nails, (e) leukonychia, (g) clubbing nails, (f) onycholysis, (h) brittle nails, (i) longitudinal striations, (j) koilonychia, (k, l) onychomycosis.

Figure 3.

Hair, hormonal and other dermatologic manifestations in patients with chronic liver disease. (a) Loss of pubic hair, (b) gynaecomastia, (c) jaundice, (d) prurigo nodularis, (e) xanthelasmas, (f–h) pigmentation, (i) leg ulcer.