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INTRODUCTION

KEY POINTS

  • Early cutaneous signs of hepatic disease can depend on the etiology of the disease, particularly whether the disease is viral, resulting from nonalcoholic fatty liver disease, or autoimmune.

  • There is a higher incidence of hepatic diseases in people with skin of color. In Caucasians, there is a higher incidence of primary biliary cirrhosis.

  • The skin findings in end-stage hepatic failure include jaundice, spider angiomas, pruritus, and many others.

  • Mixed cryoglobulinemia is the most common extrahepatic manifestation of hepatitis C, but only a small proportion of patients with cryoglobulins have a clinically evident form of hepatitis C.

  • Lichen planus and hepatitis C have a strong clinical correlation.

The epidemiology of liver disease shows that it is more prevalent in individuals with skin of color. In general, the skin gives the first clues to the signs and symptoms of liver disease. According to the Centers for Disease Control and Prevention, chronic liver disease/cirrhosis was the fifth most common cause of death among Native Americans and Alaskan Natives in 2009 and was the sixth most common cause of death among the Hispanic/Latino populations.1 The liver can be affected by a wide variety of disease processes, many of which show no predilection for skin color or gender and others which occur more widely in those with darkly pigmented skin. The causes of these diseases range from viral infections and metabolic disorders to drugs and alcohol, but the end result shared by all forms of liver disease is that, when left unchecked, the liver eventually becomes fibrotic and cirrhotic.

NONALCOHOLIC FATTY LIVER DISEASE

Epidemiology

Worldwide, nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease.2 NAFLD is a metabolic disorder that results from the accumulation of triglycerides in the hepatocytes and, as such, is strongly associated with obesity, insulin resistance, and the metabolic syndrome. Certain cultural or racial groups are known to be at greater risk of developing this disease, with the prevalence being highest in Hispanics, followed by Asians and Caucasians.3 The lowest prevalence is in African Americans.3 Patients with psoriasis have also been found to have a greater risk of developing NAFLD, which has been attributed to the higher prevalence of diabetes, obesity, and hypertension among psoriasis patients.4,5

Pathogenesis

The pathogenesis of NAFLD is not yet fully understood. Hispanics suffer from the highest rates of NAFLD, and it was initially speculated that this was a result of the high prevalence of obesity and insulin resistance within that population. However, the fact that African Americans suffer from higher rates of obesity and insulin resistance, yet have a lower prevalence of NAFLD, suggests that other factors are associated with the disease’s pathogenesis.6,7

This discrepancy could be due to variations in the enzyme adiponutrin, which hydrolyzes triacylglycerol in ...

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