Liver diseases skin changes K74.6 + Hauterkrankung

Acute and chronic liver diseases affect the integument in a variety of ways. On the one hand, the disturbed or altered metabolic functions, but also immunological reactions in liver diseases, cause skin symptoms. On the other hand, chronic liver diseases with impaired liver synthesis in particular cause skin changes (see dermadromas below).

Classification of skin diseases that can be caused or co-triggered by liver diseases:

• Acute or chronic hepatitis C/B (see hepatitis B below; see hepatitis C below)
  • Vasculitis, hepatitis C-associated.
  • Urticaria
  • Icteric phase of acute or chronic hepatitis: icterus, nevus araneus, erythema palmare et plantare symptomaticum.
  • Cryoglobulinemia
  • Erythema elevatum diutinum
  • Systemic lupus erythematosus
  • Lichen (ruber) planus
  • Pyoderma gangraenosum
  • Urticarial vasculitis
  • Preicteric hepatitis prodromal stage
    • Rare skin changes such as non-specific urticarial or maculopapular exanthema.
• Liver cirrhosis and its monitoring signs on the integument (see the respective clinical picture below):
  • Gynecomastia
  • Caput medusae
  • Silvestric sign
  • Abdominal baldness
  • Chvostek's sign
  • Money skin
  • Cryoglobulinemia
  • White nails
  • Splinter hemorrhages of the nail matrix
  • Erythema palmare et plantare symptomaticum
  • Erythema diffusum hepaticum
  • Ecchymoses, purpura
  • Various forms of telangiectasia (often also naevi aranei)
  • xanthoma
  • xanthelasma
  • Lacquer tongue ("liver tongue")
  • icterus
  • hypotrichosis
• Skin diseases in association with various chronic liver affections:
  • Dupuytren's contracture
  • Cryoglobulinemia
  • Lipomatosis, benign symmetric (irregular association with chronic liver damage)
  • Melanoderma, diffuse
  • Hyperpigmentation of the skin in hemochromatosis
  • Prurigo simplex subacuta
  • Pruritus, hepatic
  • Scleroderma, systemic (liver fibrosis, primary biliary cirrhosis)
  • Zinc deficiency dermatoses
  • Pyoderma gangraenosum
  • Cyanosis, yellow (in decompensated mitral valve defect with consecutive liver congestion)
• Hepatic co-reaction in infectious diseases affecting the integument:
  • Amoebiasis
  • Brucellosis
  • typhus
  • yellow fever
  • Herpes simplex
  • leprosy
  • Mononucleosis, infectious (enlargement of liver and spleen)
  • Relapsing fever
  • Syphilis acquisita
  • Tuberculosis
  • Weil, M.
• Hepatic (toxic) co-reaction in severe skin diseases:
  • Anticonvulsant hypersensitivity syndrome
  • Budd-Chirari syndrome (extremely rare with bleomycin therapy)
  • Stevens-Johnson syndrome.
• Affection of the liver in systemic diseases that (may) affect the integument:
  • uveal melanoma (preferably liver metastasis)
  • Metastasized malignant melanoma
  • Angiosarcoma
  • Birt-Hogg-Dubé syndrome
  • Blue-Rubber-Bleb-Naevus syndrome (angiomas of the liver)
  • Churg-Strauss syndrome
  • Hippel-Lindau syndrome (liver cavernoma)
  • Histiocytosis, Langerhans cell histiocytosis
  • Liposarcoma
  • Lymphohistiocytosis, familial hemophagocytic (liver and spleen enlargement)
  • Lymphoma, cutaneous T-cell lymphoma, cytotoxic (gamma-delta positive)
  • Melanoma, malignant (liver metastasis)
  • Panniculitis, AAT deficiency-associated
  • Panniculitis, histiocytic, cytophagic
  • Panniculitis, pancreatic (liver carcinomas)
  • Paraneoplastic syndromes of the skin in liver malignancies
  • Pustular generalized psoriasis
  • Sarcoidosis (liver infestation)
  • Sjögren's syndrome
  • Still's syndrome
  • Watson-Alagille syndrome (gait hypoplasia)
  • Xanthogranuloma, juvenile (sensu strictu) (rarely liver involvement)
  • Icterus neonatorum gravis (liver immaturity)
  • Progressive systemic scleroderma (primary biliary cirrhosis of the liver)
  • Angioendotheliomatosis, reactive (benign)
• Metabolic disorders with liver and skin changes:
  • Amyloidosis, systemic
  • Porphyria, hepatic (hyperpigmentation; blistering, milia)
  • Protoporphyria erythropoetica (possible development of liver cirrhosis)
  • Refsum syndrome
  • Gaucher, M.
  • α-1-antitrypsin deficiency
  • Lichen myxoedematosus
  • Tangier disease
  • Wilson, M. (acanthosis nigricans, hyperpigmentation).

1. Altmeyer P (2007) Dermatologic differential diagnosis. Springer Verlag, Heidelberg

2. Vande Berg P et al. (2021) How skin and liver can lead to diagnosis. Acta Gastroenterol Belg+ 84:682-683.