Study of pigmentary disorders of skin associated with underlying chronic liver disease

Abstract

Background: Chronic liver Disease is associated with a plethora of cutaneous changes which occur early in the course of disease and are significant enough to be noticed by the patient and people around. Hyperpigmentation of skin is one of the most common and important change, which can be a subtle guide to a non-dermatologist towards making an early diagnosis of underlying liver disorder.Aim: To study the clinical and histopathological profile of hyperpigmentation in patients of chronic liver disease.Materials and Methods: A prospective, observational study was done on 110 patients with chronic liver disease of varied etiology of duration more than 6 months. A detailed interrogation of the subjects was done. Presenting complaints were recorded onset, progression and duration of complaints was noted. The chronology and pattern of hyperpigmentation with regard to liver disease was noted carefully. The severity of the liver disease was assessed using Child’s criteria. Skin biopsy was done in consenting patients.Results: Pigmentary disorders were present in 49.1% of patients. The common pigmentary disorder being hyperpigmentation present in 41.8% of patients, most of the patients belonged to the category of alcoholic liver disease (40.7%).Face was the most common site affected (39.1%).Histopathological examination of these hyper pigmented skin lesions revealed increased melanin pigment in all layers of the epidermis.Conclusions: Hyperpigmentation is associated with underlying chronic liver disease. It occurs early in the course of disease and can provide subtle clues regarding the presence of underlying liver disease.