L’alcool et la peau (éthylisme) – Table des matières
Dr Christophe Hsu – dermatologist. Geneva, Switzerland
Cirrhosis
- Spider naevi:
- present in 75% of the time
- on the face and trunk
- rarely unilateral of the nevoid type, which abundance would correlate with the existence of oesophageal varicosities (Foutch et al).
Spider Nevus (Spider Angioma)
- Nails
- total apparent leuconychia (Terry’s nails): 80% of patients with cirrhosis. Proximal 2/3 white, presumed to result from reduced blood flow due to overgrowth of connective tissue.
- flat nails, koilonychia or clubbing (10-15%)
- red lunulae: due to arteriolar increased blood flow or venodulatation
- Endocrine changes
- hypogonadism: reduced facial hair growth, Soft texture. Sign of atrophy
- hyperestrogenism: gynaecomastia, spider naevi, changes in fat distribution, loss of body hair and change of pubic hair. Palmar erythrosis.
- Pseudo Cushing: Moon facies, truncal obesity, proximal muscle wasting, buffalo hump, abdomen striae, hypertension, osteoporosis. Women may have signs of virilisation, breast atrophy or menstrual irregularities
- Melanoderma (pigmented cirrhosis):
- suspect familial haemochromatosis.
- due to excess melanin in giant melanosomes in the epidermis
- cause….
- blotchy circumscribed areas of hyperpigmentation, freckling, areolar, perioral, periorbital pigmentation.
- linear pigment in the finger creases
- purpura (thromopenia or hypoprothrombinaemia)
- Other visible changes:
- Gynecomastia (relative hyperestrogenaemia)
- testicular atrophy (relative hyperestrogenaemia)
- caput medusae (due to collateral vein development)
- bilateral parotidial swelling
- icterus (cholestasis
Contributors:
Dr Christophe HSU – dermatologist. Geneva, Switzerland
National Skin Centre. Singapore
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