Skin manifestations marking a hepato-biliary pathology

Abstract

Introduction. Hepatobiliary pathologies are very often associated with changes in the skin, nails and hair that are directly or indirectly caused by these diseases. As the skin is the largest organ of the body, it often provides a clue to the underlying systemic disease, and therefore the skin manifestations in systemic disease are often encountered by dermatologists. Aim of the study. The aim of this study is to highlight the spectrum of skin changes in correlation with the pathologies of the hepatobiliary system. Methods and materials. Several bibliographic sources have been studied: articles, textbooks, electronic databases (Medscape, PubMed, etc.). Results. Most studies reported the most common pathologies of the hepatobiliary system, including hepatitis B (32%), followed by alcoholic liver disease (26%), viral hepatitis C (14%), cholestatic liver disease (8%), hepatocellular carcinoma (6%), Wilson's disease (4%) and autoimmune disease (2%). Among the extrahepatic manifestations in hepatobiliary pathologies, the skin is most frequently involved. The cutaneous manifestations in chronic hepatitis are represented by vascular, pigmentary and annex changes. Most studies reported a wide range of skin manifestations, the most common being xerosis and excoriation, pruritus, jaundice, pigment changes (hypo-hyperpigmentation), spider angioma, Terry's nails, palmar erythema. Chronic hepatitis C virus infection is currently considered a systemic condition with multiorgan involvement. The association of chronic hepatitis C virus infection with a lot of skin manifestations has been widely reported in the literature. In registry-based studies, approximately 17% of hepatitis C virus patients have at least one manifestation of the skin, which may be directly or indirectly induced by chronic hepatitis C virus infection. The most common skin manifestations associated with chronic hepatitis C virus infection due to a strong epidemiological and pathogenetic association are mixed cryoglobulinemia, lichen planus and late cutaneous porphyria. Stellar angiomas, palmar erythema and contracture of Dupuytren are observed in approximately 72% of cases in patients with alcoholic cirrhosis. 80% of them have a concave nail, Terry's white nail and a clock glass nail. Conclusion. In conclusion, the pathology of the hepatobiliary system can give a wide range of skin manifestations, such as xerosis, pruritus, pigment changes, spider angioma. These manifestations are nonspecific as not suggested by a specific diagnosis, but may reflect the severity of liver disease.