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Heydarirad G, Rastegar S, Haji-Abdolvahab H, Fuzimoto A, Hunter J, Zare R, Pasalar M. Efficacy and safety of purslane (Portulaca oleracea) for mild to moderate chronic hand eczema; A randomized, double-blind, placebo-controlled clinical trial. Explore (NY) 2024; 20:401-410. [PMID: 37872023 DOI: 10.1016/j.explore.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Chronic hand eczema (CHE) is a common skin inflammation with a complex pathophysiology. Due to its anti-inflammatory properties, Portulaca oleracea L. (purslane) is traditionally used in Persian medicine for skin ailments. This study aimed to evaluate the safety and efficacy of a standardized purslane extract (based on traditional Persian medicine) for adults with mild or moderately severe CHE. METHODS A randomized, double-blind, placebo-controlled clinical trial was conducted at Razi Hospital in Iran from January to June 2022. Participants were randomly allocated to receive an oral purslane or placebo syrup plus topical Vaseline for four weeks. Seventy participants were randomly allocated into the intervention (n = 35) and placebo (n = 35) groups. The primary outcomes were the extent and severity of CHE symptoms over the four weeks after adjusting for age, gender and baseline score. Secondary outcomes were quality of life, symptom recurrence, treatment satisfaction, and adverse events. RESULTS After 4 weeks of treatment, compared to the placebo group (n = 31), the purslane group (n = 31) had significantly lower physician-reported fissure scores (adjusted mean difference (adjMD): -0.50, 95 %CI -3.93 to -0.34, p = 0.043), participant-reported itching (adjMD -0.51, 95 %CI -2.32 to -0.31, p = 0.041), dryness (adjMD -1.46, 95 %CI -2.89 to -0.03, p = 0.045), and total itching, dryness and thickness (adjMD -2.36, 95 %CI -6.23 to -1.51, p = 0.023) scores. Fourteen participants (purslane n = 10; placebo n = 4, p = 0.068) experienced adverse events of mild to moderate severity. CONCLUSION Purslane has some promising effects for reducing the extent and severity of CHE symptoms, and no direct comparisons have been made with commonly used treatments. Future multicenter trials and mechanistic studies are warranted to establish the safety and effectiveness of purslane as a potential therapeutic agent for CHE. TRIAL REGISTRATION Iranian Registry of Clinical Trials (IRCT20200707048040N1).
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Affiliation(s)
- Ghazaleh Heydarirad
- Traditional Medicine and Materia Medica Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sedigheh Rastegar
- Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Jennifer Hunter
- Director, Health Research Group, Sydney, New South Wales, Australia
| | - Roghayeh Zare
- Research Center of Persian Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mehdi Pasalar
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Liu Y, Zhao Y, Gao X, Liu J, Ji F, Hsu YC, Li Z, Nguyen MH. Recognizing skin conditions in patients with cirrhosis: a narrative review. Ann Med 2022; 54:3017-3029. [PMID: 36308406 PMCID: PMC9629063 DOI: 10.1080/07853890.2022.2138961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The skin is a major target organ for extrahepatic manifestations of liver diseases, and dermatologic abnormalities are common in patients with hepatic disorders. Clinical examination of the skin, nails and hair can allow for appropriate recognition, early diagnosis and treatment of liver diseases, and improvement in the quality of life and life expectancy of affected patients.Methods: We searched 3 databases (Pubmed,Medline and Embase) and selected studies about cirrhosis related skin manifestations and their pathophysiology.Results: A total of 73 articles were included in the review. Studies displayed the spectrum of cutaneous manifestations related to hormonal and vascular changes as well as nail and hair changes in patients with cirrhosis and/or portal hypertension.Conclusion: Cutaneous alterations are important clues or potential indications in the diagnosis of liver cirrhosis. Familiarity with skin conditions can be promptly diagnosed and appropriate management initiated.KEY MESSAGESManifestations of the liver and skin disorders are interrelated in various ways. Cutaneous changes may be the first clue that a patient has liver disease.The skin is a major target organ for extrahepatic manifestations of liver diseases. A broad range of cutaneous alterations can be present in patients with cirrhosis, such as vascular, nail, hair, hormonal changes, etc.Recognizing these signs is crucial so that potential underlying diseases including liver disease can be promptly diagnosed and appropriate management timely initiated.
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Affiliation(s)
- Ying Liu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yunyu Zhao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xu Gao
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Gastroenterology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiashu Liu
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Fanpu Ji
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,National & Local Joint Engineering Research Center of Biodiagnosis and Biotherapy, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yao-Chun Hsu
- Center for Liver Diseases, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, Fu Jen Catholic University Hospital, New Taipei, Taiwan
| | - Zhengxiao Li
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mindie H Nguyen
- Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, CA, USA.,Department of Epidemiology and Population Health, Stanford University, Palo Alto, CA, USA
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Abstract
Skin manifestations of systemic disorders give a clue to the organ involved and help identify the possible disease-causing injury. Skin changes of liver cirrhosis are not specific, as they may be seen in disorders not involving the liver. Thus, a constellation of skin changes along with systemic features may help us to identify the disease-causing liver cirrhosis. Pruritus is one of the most common and distressful symptoms of liver cirrhosis, severely affecting the quality of life, which further necessitates understanding cutaneous manifestations of cirrhosis. Other nonspecific cutaneous manifestations include spider telangiectasia, palmar erythema, paper money skin, xanthomas, pigmentation changes, nutritional deficiencies, hair changes, and nail changes. This review discusses the nonspecific skin manifestations associated with liver cirrhosis followed by specific cutaneous findings seen in common diseases causing liver cirrhosis, such as viral infections, biliary tract disorders, chronic alcoholism, and metabolic disorders. Early recognition of cutaneous features can help prevent or delay the development of complications and end-stage disease, decreasing morbidity and mortality.
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Key Words
- HBV, Hepatitis B Virus
- HCV, Hepatitis C Virus
- LPA, Lysophosphatidic acid
- PAN, polyarteritis nodosa
- PBC, Primary biliary cirrhosis
- PCT, Porphyria Cutanea Tarda
- PSC, Primary Sclerosing cholangitis
- UROD, uroporphyrinogen decarboxylase
- VEGF, vascular endothelial growth factor
- bFGF, basic fibroblast growth factor
- cirrhosis
- cutaneous manifestations
- skin changes
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Leal JM, de Souza GH, Marsillac PFD, Gripp AC. Skin manifestations associated with systemic diseases - Part II. An Bras Dermatol 2021; 96:672-687. [PMID: 34544639 PMCID: PMC8790166 DOI: 10.1016/j.abd.2021.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 06/02/2021] [Accepted: 06/11/2021] [Indexed: 12/23/2022] Open
Abstract
The skin, by reflecting internal processes, externalizes what happens inside the body in many diseases. Thus, the skin, as an organ, extrapolates its functions of protection, barrier and signals the existence of systemic diseases, expanding the importance of the dermatologist beyond the skin surface. Thus, the dermatologist investigates diagnostic hypotheses for conditions related to all systems and refers patients to the appropriate specialty. Combined with examination by a trained eye, the skin, due to its easy access, is still the ideal place for performing biopsies, which often clarify the diagnosis. This manuscript is the second part of the article on cutaneous manifestations of systemic diseases. In the first part, the cutaneous manifestations of the main rheumatologic and granulomatous diseases were described, and vascular manifestations were also addressed. In the present article, it will be discussed how metabolic, cardiovascular, kidney, and gastrointestinal diseases can manifest themselves in the integumentary system. Malignant diseases and their cutaneous implications, will also be discussed. Pruritus and its clinical cutaneous correspondence will be discussed. Finally, an update on cutaneous signs of SARS-CoV2 coronavirus infection will be presented.
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Affiliation(s)
- Juliana Martins Leal
- Service of Dermatology, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil.
| | | | | | - Alexandre Carlos Gripp
- Service of Dermatology, Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ, Brazil
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Facial appearance and metabolic health biomarkers in women. Sci Rep 2020; 10:13067. [PMID: 32747662 PMCID: PMC7398920 DOI: 10.1038/s41598-020-70119-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/15/2020] [Indexed: 12/13/2022] Open
Abstract
Facial appearance has been suggested to provide an honest cue of an individual’s biological condition. However, there is little direct evidence that facial attractiveness reflects actual health. Here we tested if facial appearance is related with metabolic health biomarkers. Face photographs of 161 healthy, young women (Mage = 28.59, SDage = 2.34) were assessed in terms of perceived attractiveness and health. Metabolic health was evaluated based on levels of markers of lipid and glucose metabolism balance, liver functioning, and inflammation. BMI, testosterone (T), and estradiol (E2) levels were controlled. Facial attractiveness, but not health, was negatively related with lipid profile components detrimental to health (total cholesterol, LDL, triglycerides) but not with relatively protective for health HDL. When controlled for BMI, E2, and T, only the relationship between attractiveness and triglycerides remained significant. Facial appearance was unrelated with glucose metabolism, liver functioning, and inflammatory markers. The results suggest, that for healthy women of reproductive age, such measures as BMI and sex hormone levels may be better predictors of attractiveness, compared to measures of metabolic health. Markers of lipid, glucose homeostasis, liver functioning or low-grade inflammation may be rather indicators of future health, of lesser importance in mating context, thus only modestly reflected in facial appearance.
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Ozeki I, Yamaguchi M, Suii H, Tatsumi R, Arakawa T, Nakajima T, Kuwata Y. The association between serum zinc levels and subjective symptoms in zinc deficiency patients with chronic liver disease. J Clin Biochem Nutr 2020; 66:253-261. [PMID: 32523253 DOI: 10.3164/jcbn.19-99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/04/2019] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the association between serum zinc levels and major subjective symptoms in zinc deficiency patients with chronic liver disease. 578 patients with chronic liver disease were enrolled. The patients, whose serum zinc level of <80 µg/dl, completed a questionnaire to determine whether they had subjective symptoms of the five conditions (taste disorder, aphthous stomatitis, dermatitis, alopecia, and anorexia). Then, the association between these subjective symptoms and serum zinc levels was analyzed. In total, 193 patients (33.4%) experienced any subjective symptoms. The prevalence of each symptom was as follows: 36 patients with taste disorder (6.2%), 46 with aphthous stomatitis (8.0%), 77 with dermatitis (13.3%), 46 with alopecia (8.0%), and 53 with anorexia (9.2%). In total, 70.8%, 34.1%, and 26.1% patients with serum zinc levels of <40, ≥40 to <60, and ≥60 to <80 µg/dl, respectively, had these symptoms. When zinc deficiency was defined as a serum zinc level of <80 µg/dl, approximately one-third of patients displayed symptoms presumably originating from zinc deficiency. As serum zinc levels decreased, the prevalence of these symptoms increased. Dermatitis, especially, was relevant to zinc.
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Affiliation(s)
- Itaru Ozeki
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
| | - Masakatsu Yamaguchi
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
| | - Hirokazu Suii
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
| | - Ryoji Tatsumi
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
| | - Tomohiro Arakawa
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
| | - Tomoaki Nakajima
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
| | - Yasuaki Kuwata
- Department of Hepatology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo 060-0033, Japan
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Huang A, Desai A, Brinster N, Marmon S. Telangiectasia macularis eruptiva perstans in the presence of liver cirrhosis. JAAD Case Rep 2020; 6:438-440. [PMID: 32382640 PMCID: PMC7200198 DOI: 10.1016/j.jdcr.2020.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Ozeki I, Nakajima T, Suii H, Tatsumi R, Yamaguchi M, Arakawa T, Kuwata Y, Toyota J, Karino Y. Evaluation of treatment with zinc acetate hydrate in patients with liver cirrhosis complicated by zinc deficiency. Hepatol Res 2020; 50:488-501. [PMID: 31729098 DOI: 10.1111/hepr.13461] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/12/2022]
Abstract
AIM In Japan, no zinc preparation had been approved for therapeutic purposes before March 2017. Zinc acetate hydrate was recently approved for the treatment of hypozincemia. We evaluated the efficacy and safety of treatment with zinc acetate hydrate. METHODS A total of 97 patients with cirrhosis complicated by hypozincemia were treated with zinc acetate hydrate, and their serum zinc normalization rates; factors contributing to normalization; changes in blood ammonia levels; branched-chain amino acids-to-tyrosine ratios; levels of albumin, hemoglobin, alkaline phosphatase, serum copper, and iron; incidence of adverse events; improvement in subjective symptoms; and serum zinc levels taken at 3 months post-treatment were determined. RESULTS The cumulative serum zinc normalization rates, when normalization was defined as achievement of a serum zinc level ≥80 μg/dL, after 2, 4, and 6 months of treatment were 64.9%, 80.3%, and 82.5%, respectively. Multivariate analysis identified an albumin level of ≥3.3 g/dL and branched-chain amino acids to tyrosine ratio of ≥3.46 as factors contributing to zinc normalization within 3 months of treatment. Treatment resulted in a significant decrease in blood ammonia and serum copper levels, and significant increases in branched-chain amino acids-to-tyrosine ratios and alkaline phosphatase levels. Seven (7.2%) patients prematurely discontinued treatment due to hypocupremia. By the end of treatment, subjective symptoms had resolved in 46.2% of patients. By 3 months post-treatment, serum zinc levels had reverted to levels close to those at baseline. CONCLUSIONS Treatment with zinc acetate hydrate resulted in normalization of serum zinc levels at a high rate. The main reasons for discontinuation of treatment included hypocupremia.
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Godara SK, Thappa DM, Pottakkatt B, Hamide A, Barath J, Munisamy M, Chiramel MJ. Cutaneous manifestations in disorders of hepatobiliary system. Indian Dermatol Online J 2017; 8:9-15. [PMID: 28217465 PMCID: PMC5297287 DOI: 10.4103/2229-5178.198760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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. AIM 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. CONCLUSION The common mucocutaneous manifestations associated with primary hepatobiliary disorders were icterus, ichthyosis/xerosis, pallor, excoriations, hyperpigmented palmar creases, clubbing, and pedal edema.
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Affiliation(s)
- Shashi K Godara
- Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Devinder M Thappa
- Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Biju Pottakkatt
- Department of Medical Gastroenterology, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Abdoul Hamide
- Department of Medicine, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Jagadisan Barath
- Department of Paediatrics, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Malathi Munisamy
- Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India
| | - Minu J Chiramel
- Department of Dermatology, Jawaharlal Institute of Medical Education and Research, Puducherry, India
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Noble A, Greenstein J, Husain A, Zielinski M, Hahn B. Periorbital melanosis. Am J Emerg Med 2016; 35:380.e1-380.e2. [PMID: 27624368 DOI: 10.1016/j.ajem.2016.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anja Noble
- Department of Emergency Medicine, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Joshua Greenstein
- Department of Emergency Medicine, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Abbas Husain
- Department of Emergency Medicine, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Margaret Zielinski
- Department of Emergency Medicine, Staten Island University Hospital Northwell Health, Staten Island, NY
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital Northwell Health, Staten Island, NY.
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Wang G, Chen H, Yang Y, Wu K, Sun J. Telangiectasia macularis multiplex acquisita accompanied by hepatitis B infection. Australas J Dermatol 2015; 58:e5-e7. [PMID: 26507226 DOI: 10.1111/ajd.12398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 08/13/2015] [Indexed: 11/29/2022]
Abstract
We describe two rarely documented cases of telangiectasia macularis multiplex acquisita (TMMA) with a history of hepatitis B infection. Both patients presented with multiple erythematous macules and telangiectasia on bilateral upper arms and the upper part of the trunk. Patient 1 also had spider naevi on the upper part of the chest and palmar erythema; thus we inferred that TMMA, like spider naevi and palmar erythema, might belong to the spectrum of vascular changes of liver diseases.
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Affiliation(s)
- Guangping Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Hao Chen
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Ying Yang
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu Province, China
| | - Kan Wu
- Zhuhai Xiguang Polyclinic, Zhuhai, Guangdong Province, China
| | - Jianfang Sun
- Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, Jiangsu Province, China
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Young S, Kwarta E, Azzam R, Sentongo T. Nutrition assessment and support in children with end-stage liver disease. Nutr Clin Pract 2013; 28:317-29. [PMID: 23466471 DOI: 10.1177/0884533612474043] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Malnutrition is a treatable complication in children with end-stage liver disease (ESLD). Biliary atresia and other cholestatic disorders are the most frequent cause of ESLD in children. No single variable provides adequate information about nutrition status, yet effective nutrition support is the one intervention known to improve pre- and posttransplant outcomes. A proactive approach consisting of screening anthropometry interpreted using appropriate growth references, recognition of clinical manifestations associated with micronutrient deficiency, and timely aggressive nutrition support is of a paramount importance to maximize anabolism and optimize outcomes. This article presents the principles of nutrition assessment, intervention, and monitoring in children with ESLD.
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Affiliation(s)
- Sona Young
- University of Chicago, Chicago, IL 60637, USA
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Abstract
The skin should not be considered as an isolated organ but rather as a definite functioning system that communicates with the internal environment. Skin signs of systemic diseases occur frequently and sometimes feature the first symptoms of an internal disease; furthermore, these manifestations may be the sole expressions of otherwise asymptomatic systemic disorders. A number of dermatologic signs, symptoms, and disorders can be invaluable as markers of systemic disease. Although a plethora of specialized modern diagnostic tests are available, the skin still remains the only organ of the body that is immediately and completely accessible to direct clinical examination. This contribution reviews the skin signs of systemic diseases. The description of the clinical features of skin lesions observed in several internal diseases will be useful to general physicians, internists, and dermatologists in the diagnosis of a systemic disease.
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Affiliation(s)
- Dimitris Rigopoulos
- Department of Dermatology, University of Athens, Andreas Sygros Hospital, 5th Ionos Dragoumi St, 16121 Athens, Greece.
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[Skin signs of systemic diseases]. Internist (Berl) 2008; 50:137-49. [PMID: 19096815 DOI: 10.1007/s00108-008-2206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Many aspects of cutaneous signs are of importance to nondermatologists, as skin manifestations can reflect internal disease states, either directly or as a result of a complication or treatment and therefore can lead to the diagnosis of systemic illness. Serious morbidity and mortality can be avoided by early recognition of only minor cutaneous manifestations signaling internal problems. Limited forms of collagen vascular disease exemplify the important marker function of the skin for diagnosis as well as for prognosis with their typically favorable course permitting a less aggressive treatment. The utmost important prerequisite of diagnosing skin conditions is an accurate and thorough examination of the skin, the adjacent mucous membranes and the integumentary appendages. In a first step, the primary site of the cutaneous condition should be identified (e.g. epidermal, dermal or subdermal) and then the form, the pattern, and distribution should be recognized. There are many comprehensive and excellent textbooks available for guidance. This article focuses on the more common dermatologic conditions linked to different organ systems involved (excluding infectious diseases, metabolic diseases and drug induced conditions).
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