title: Cutaneous manifestations in disorders of hepatobiliary system.
abstract: BACKGROUND
  Hepatobiliary diseases are associated with various mucocutaneous changes that are directly and indirectly associated with these diseases. There is a dearth of studies from India dealing with cutaneous manifestations in liver disorders.
  
  
  OBJECTIVE
  This study was conducted to know the spectrum of cutaneous changes and their correlation with liver function tests in patients with disorders of hepatobiliary system.
  
  
  METHODS
  This was a descriptive study conducted among in patients and outpatients with primary hepatobiliary disorders at a tertiary care center in South India. Detailed history taking and examination was done. Visual analog score (VAS) and 5D itch score was employed to quantify pruritus. Correlation of liver function tests with pruritus and comparison of skin changes in the major disease groups was attempted.
  
  
  RESULTS
  A total of 303 patients were recruited. Hepatic mass/malignancy followed by nonalcoholic liver disease were the most common diagnoses. Icterus followed by pruritus were the most common cutaneous complaints. The mean VAS and 5D itch scores among the patients with pruritus were 4.7 ± 1.9 and 13.6 ± 4.9. The most common mucocutaneous findings observed were icterus (241 patients; 79.5%), ichthyosis/xerosis (172 patients; 56.7%), pallor (131 patients; 43.2%), excoriations (118 patients; 38.9%), hyperpigmented palmar creases (118 patients; 38.9%), clubbing (113 patients; 37.2%), and pedal edema (85 patients; 28%). There was statistically significant correlation between serum bilirubin levels and pruritus.
  
  
  CONCLUSIONS
  The common mucocutaneous manifestations associated with primary hepatobiliary disorders were icterus, ichthyosis/xerosis, pallor, excoriations, hyperpigmented palmar creases, clubbing, and pedal edema.
authors.affiliation: Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Shashi K
authors.initials: SK
authors.lastname: Godara
authors.affiliation: Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Devinder M
authors.initials: DM
authors.lastname: Thappa
authors.affiliation: Department of Medical Gastroenterology, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Biju
authors.initials: B
authors.lastname: Pottakkatt
authors.affiliation: Department of Medicine, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Abdoul
authors.initials: A
authors.lastname: Hamide
authors.affiliation: Department of Paediatrics, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Jagadisan
authors.initials: J
authors.lastname: Barath
authors.affiliation: Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Malathi
authors.initials: M
authors.lastname: Munisamy
authors.affiliation: Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India.
authors.forename: Minu J
authors.initials: MJ
authors.lastname: Chiramel
keywords: Hepatitis; liver disorders; skin changes