Doctors detailed the skin changes that occur in cases of cirrhosis, as published in the Journal of Clinical and Experimental Hepatology. Cirrhosis or liver fibrosis caused by long-term liver damage can be caused by a number of conditions including viral infections, metabolic disorders, and biliary tract diseases such as Alagille syndrome.

Alagille syndrome is caused by genetic mutations either in the Jagged 1 gene (in more than 90% of cases) or the Notch 2 gene, disrupting the Notch signaling pathway. The disease is characterized by bile duct paucity.

The authors of the review grouped the skin changes caused by cirrhosis into 2 main categories: those that are nonspecific and those that are disease-specific.

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Read more about Alagille syndrome etiology

Nonspecific skin changes include pruritus, spider angioma, palmar erythema, xanthelasma, and jaundice, the authors said. Cutaneous changes that are specific to Alagille syndrome include severe itching and widespread xanthomas.

The itching is caused by the retention of bile acid in the liver because there are too few bile ducts to drain the bile out of the liver. The xanthomas are the result of cholesterol depositing under the skin and can be disfiguring in some cases. They could both be an indication of cirrhosis.

“Skin changes can aid in the early diagnosis of liver cirrhosis and many of them can help us to suspect the etiological cause,” Adhyatm Bhandari, MD, DNB, and Rahul Mahajan, MD, MAMS, concluded.

They also stressed the importance of early detection of cirrhosis so that the development of complications and end-stage liver disease can be prevented or delayed. This, in turn, could improve the survival and quality of life of patients, they said.


Bhandari A, Mahajan R. “Skin changes in cirrhosis“. J Clin Exp Hepatol. Published online December 27, 2021. doi:10.1016/j.jceh.2021.12.013