Diagnosing liver fibrosis: a narrative review of current literature for dermatologists. (3rd August 2017)

• Record Type: Journal Article
• Authors: Potts, J.R.; Maybury, C.M.; Salam, A.; Barker, J.N.; Agarwal, K.; Smith, C.H.
• Is Part Of: British journal of dermatology. Volume 177:Number 3(2017)
• Page Start: 637
• Page End: 644
• Publication Date: 2017-08-03
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.15246
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: 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. Abstract : What's already known about this topic? Dermatologists may perform tests that show evidence of liver fibrosis when investigating a patient with risk factors for liver disease or as a consequence of routine blood testing, screening patients for systemic therapies or managing inpatients. Dermatologists may be aware of advances in the development of tests to identify liver fibrosis but unsure of how to use them in their own practice. What does this study add? This review reports on the increasing prevalence of liver disease in the general population and the risk factors for fibrosis in patients with skin disease. We summarize current recommendations for the diagnosis of liver fibrosis in the general population. We highlight areas for further research relevant to dermatologists. Linked Comment: de Knegt. Br J Dermatol 2017; 177 :610–611