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

Cirrhosis

• Spider nevi:

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 esophageal varicosities (Foutch et al).

• 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 venodilation.

• Endocrine changes

1. hypogonadism: reduced facial hair growth, Soft texture. Sign of atrophy
2. hyperestrogenism: gynecomastia, spider nevi, 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 virilization, 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

Source of information: here