Alcohol (OH) and the Skin – Cirrhosis (For professionals)

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Cirrhosis

• Spider naevi:

1. present in 75% of the time
2. on the face and trunk
3. rarely unilateral of the nevoid type, which abundance would correlate with the existence of oesophageal varicosities (Foutch et al).

Spider Nevus (Spider Angioma)

• Nails

1. 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.
2. flat nails, koilonychia or clubbing (10-15%)
3. red lunulae: due to arteriolar increased blood flow or venodulatation

• Endocrine changes

1. hypogonadism: reduced facial hair growth, Soft texture. Sign of atrophy
2. hyperestrogenism: gynaecomastia, spider naevi, changes in fat distribution, loss of body hair and change of pubic hair. Palmar erythrosis.
3. 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):

1. suspect familial haemochromatosis.
2. due to excess melanin in giant melanosomes in the epidermis
3. cause….
4. blotchy circumscribed areas of hyperpigmentation, freckling, areolar, perioral, periorbital pigmentation.

• linear pigment in the finger creases

• purpura (thromopenia or hypoprothrombinaemia)

• Other visible changes:

1. Gynecomastia (relative hyperestrogenaemia)
2. testicular atrophy (relative hyperestrogenaemia)
3. caput medusae (due to collateral vein development)
4. bilateral parotidial swelling
5. icterus (cholestasis

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore