Table 3.
Hair, hormonal and other changes associated with liver and non-liver conditions.
| Cutaneous condition | Figure | Characteristics of skin lesions | Associated liver conditions | Prevalence | Pathogenesis of cirrhosis related skin conditions | Associated non-liver conditions |
|---|---|---|---|---|---|---|
| Hair | ||||||
| Loss of pubic hair or beard | Figure 3(a) | Loss of pubic hair | Cirrhosis | NA | Elevated oestrogen level | Trichotillomania Hypothalamic dysfunction XYY-male Sheehan’s syndrome Menopause Treatment with glucocorticoids |
| Hormonal changes | ||||||
| Gynaecomastia | Figure 3(b) | Breast enlargement | Cirrhosis | 44% | Elevated oestrogen level | Extreme obesity Hypogonadism Adrenal disease Tumours of the adrenal glands, pituitary, lungs and testes Use of digoxin, thiazides, oestrogens, phenothiazines and theophylline Use of methotrexate, alkylating agent, imatinib and vinca alkaloids Use of marijuana Transexual woman Thyroid disorders |
| Others | ||||||
| Pruritus | Cholestatic liver diseases Cirrhosis |
40-60% | Bile salts, endogenous opioids, serotonin, progesterone metabolites and lysophosphatidic acid | Medications Allergies Atopic dermatitis Psoriasis Kidney disease |
||
| Xanthelasma | Figure 3(e) | Pale yellow, planar or slightly bulged, soft plaques around the eyelids | Cholestatic liver disease | NA | Hypercholesterolaemia | Autosomal dominant form of hereditary hypercholesterolaemia Hypercholesterolaemia |
| Pigmentation | Figure 3(f–h) | Blotchy or diffuse muddy gray coloured hyperpigmentation in the pretibial area | Cirrhosis | 46.9% | Red blood cells extravasation and deposition of hemosiderin due to lower extremity edoema and obstruction of venous reflux | Physical dermatosis Inflammatory dermatoses Immunologic dermatoses Allergic/hypersensitivity Cardiac abnormalities |
| Leg ulcer | Figure 3(i) | Necrotic tissue adhering to basilar part and raised edge | Cirrhosis | NA | Hypoxia-ischemia induced by lower extremity edoema and obstruction of venous reflux | Chronic venous insufficiency Peripheral arterial occlusive disease Vasculitis Diabetes Pyoderma gangrenosum Martorell hypertensive leg ulcer |
| Coagulation defects | Skin petechiae, ecchymosis, or mucosal bleeding | Cirrhosis | NA | Thrombocytopenia, hyperfibrinolysis, reduction in most factors and inhibitors of clotting and fibrinolytic systems |
Haematological diseases Trauma Diabetes Uraemia Anticoagulant therapy for thrombotic diseases |
|
NA: Data unavailable.