title: Diagnosing liver fibrosis: a narrative review of current literature for dermatologists.
abstract: Chronic liver disease is a growing problem worldwide due to obesity, alcohol-related liver disease and viral hepatitis. Liver fibrosis is generally asymptomatic and patients may not present until they have advanced cirrhosis, when the scope for reversibility is limited. Identification of asymptomatic individuals at an early stage is fundamental to reversing the rising toll of liver-related morbidity and mortality. Awareness of liver disease and the techniques for diagnosis is important for dermatologists, not only due to the burden of disease in the general population but also because some dermatology cohorts may have an elevated risk. For example, there is an increased prevalence of metabolic syndrome and excess alcohol use in those with psoriasis and hidradenitis suppurativa. In isolation, standard liver function tests lack sensitivity to detect advanced fibrosis and cirrhosis and are of limited value. Traditionally diagnosis has relied on liver biopsy, which remains the gold standard but is both costly and invasive. There have been several recent advances in the development of noninvasive alternatives. These include scoring systems combining clinical and conventional laboratory parameters for use as screening tools, direct serum biomarkers of fibrogenesis and tissue elastography using both ultrasound (Fibroscan) and magnetic resonance. This review summarizes current and future noninvasive diagnostic techniques for evaluation of liver fibrosis.
authors.affiliation: Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, U.K.
authors.forename: J R
authors.initials: JR
authors.lastname: Potts
authors.affiliation: St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, King's College London, London, U.K.
authors.forename: C M
authors.identifier: http://orcid.org/0000-0001-5860-3785
authors.initials: CM
authors.lastname: Maybury
authors.affiliation: St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K.
authors.forename: A
authors.initials: A
authors.lastname: Salam
authors.affiliation: St John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, King's College London, London, U.K.
authors.forename: J N
authors.initials: JN
authors.lastname: Barker
authors.affiliation: Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, U.K.
authors.forename: K
authors.initials: K
authors.lastname: Agarwal
authors.affiliation: St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, U.K.
authors.forename: C H
authors.initials: CH
authors.lastname: Smith
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy / Q000379:methods; D002908:Chronic Disease; D042241:Early Diagnosis; D054459:Elasticity Imaging Techniques / Q000379:methods; D005544:Forecasting; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging / Q000379:methods; D017410:Practice Guidelines as Topic; D012015:Reference Standards; D018570:Risk Assessment / Q000379:methods; D014463:Ultrasonography / Q000379:methods
chemical_list: D015415:Biomarkers