Skin Manifestations of Liver Diseases in Sohag University Hospital, Egypt.

1. EssamEldin A Nada, MD1; Ghada MK Galal, MD2; Ramadan SA Saleh, MD1 and Marwa M Abd-El Meged, MSc.1 1Dermatology, Venereology and Andrology and 2Tropical Medicine and Gastroenterology Departments, Faculty of Medicine, Sohag University, Egypt. Skin Manifestations of Liver Diseases in Sohag University Hospital, Egypt.

2. Objectives: The aims of this work to study patterns of skin manifestations in patients with liver diseases in Sohag University Hospital, Egypt and to determine socio-demographic factors related to the presence of dermatological conditions in those patients. skin manifestations in patients with liver diseases in Sohag governorate . Patients and Methods: 800 patients with clinical and/ or laboratory diagnosis of liver diseases attended the Tropical Medicine and Gastroenterology department in Sohag University Hospital, between October 2009 - October 2010. Personal data and medical history were taken. Patients with history of associated endocrinal disorders e.g.; diabetes mellitus, thyroid disease or chronic renal illness and patients receiving antivirals therapy were excluded from study. Patients of liver cirrhosis were categorized as compensated and decompensated according to modified Child- Push classification of severity of liver disease (Push et al, 1973).Complete dermatological examination was performed for skin, mucous membranes, hair and nails. Results: 490 of 800( 61.25%) patients with liver diseases were with mean age 50.83 ± 11.51 years The majority of patients were above 40 years old (86.29%), farmers (70.50%), residents of rural areas (85.75%), married ( 81.50%) and were nonsmoker (72.50%).The majority of patients were diagnosed as liver cirrhosis (68.63%), more than half of the cirrhotic patients (53.19%) were compensated with duration of liver illness ranging from more than 1 to 5 years (60%) . Bilharziasis was found in 338/ 800 (42.25%).Previous operation in 124/800 (15.5%).Blood transfusion in 26/800 (3.25%). Positive family history of liver disease was found in 133/ 800 (16.63%)(Table 1-2).

3. Cutaneous manifestations were found in 752 / 800 (94%) of patients with liver diseases. Nail changes were the most common cutaneous manifestation (86.87%) and white nails was the commonest abnormality (24.88%).Vascular changes were detected in 83.12%. Palmar erythema was the commonest vascular change in (54.50%). Facial hyper pigmentation was found in 56.37%. Muddy face was the most common one (29.88%) (Table 3). In this study, jaundice was found in 191/ 800 (23.88%), Lichen planus was detected in 90/ 800 (11.25%). Acquired ichthyosis was detected in 44/800 (5.5%). Lichen simplex chronicus (3.25%), cutaneous vasculitis (2.25%), vitiligo vulgaris (1.75%), idiopathic guttate hypomelanosis (1.50%) and necrolytic acral erythema (1.25%). Conclusions: This study highlights the patterns of cutaneous manifestations of liver diseases in Sohag University Hospital, Egypt. Based on the results of this study, liver diseases are commonly associated with various dermatological disorders. Patients with liver cirrhosis are at higher risk of developing skin lesions.

4. Table1: Comparisons of personal data between patients with liver diseases who had cutaneous manifestations and those who had no cutaneous manifestations * significant

5. Table2: Comparison between patients with and without cutaneous manifestations according to diagnosis, duration and severity of liver diseases * significant

6. Table3:Patterns of skin manifestations, nail, hair and oral mucosal changes in patients with liver diseases * significant