Clinical

Skin disorders common in primary biliary cirrhosis

Last Updated: 2006-03-24 8:30:21 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Patients with primary biliary cirrhosis have a wide variety of cutaneous manifestations, Greek researchers report in the March issue of the American Journal of Gastroenterology. This can be helpful in the diagnosis of primary biliary cirrhosis, and in fact a dermatological condition may be the presenting sign or symptom.

Lead investigator Dr. Meri Koulentaki told Reuters Health that the disease, of probable autoimmune etiology, "affects the small intrahepatic bile ducts of mainly middle-aged women, leading to liver cirrhosis. Early stage primary biliary cirrhosis may be oligo- or asymptomatic and therefore the diagnosis often is made at the late disease stages."

It is commonly associated with skin conditions, including pruritus and melanosis, and to characterize such manifestations Dr. Koulentaki and colleagues at University Hospital, Heraklion, compared 49 patients with 45 matched controls.

In all, 330 instances of skin disorder were found in the patients with primary biliary cirrhosis compared with 76 in the controls. In addition 43 of the patients had dermatological symptoms versus 14 of the controls.

The most common disorders seen in the patients were fungal infections (31.5%). Also common were neoplastic lesions (18.4%), dermatitis-urticaria (15.7%) and disturbances in pigmentation (12.4%).

Overall, 69.3% of patients had pruritus, the same proportion had xerosis, and 57.1% had dermographism. Corresponding proportions in controls were, 22.2%, 2.2% and 4.4%. No controls had melanosis but this was seen in 46.9% of patients.

Thus, continued Dr. Koulentaki, "dermatologic lesions -- most commonly cutaneous fungal infections -- are very common even in the early stages of biliary cirrhosis. Indeed, in more than one third of our patients, the dermatologic lesion was the presenting sign or symptom leading to diagnosis."

Physicians should be aware of these manifestations, Dr. Koulentaki concluded, "in order to achieve a prompt and early diagnosis, since early treatment could alter the disease progression."

Am J Gastroenterol 2006;101:541-546.