Manifestations cutanéomuqueuses des affections hépatobiliaires et pancréatiques

Abstract

Hepatobiliary and pancreatic affections may result in numerous cutaneous manifestations; these have often an indication value that makes them highly interesting for the dermatologist. Their frequency is variable and, in some of them, the evolution is progressive. The frequency of combined hepatitis B + disseminated necrotizing periarteritis which was estimated to be from 30% to 45% has been lowered to about 7% as a result of vaccination campaigns. Conversely, the frequency of the affections related to hepatitis C, in particular cryoglobulinaemia-induced angeitis, has increased. In France, hepatitis C seroprevalence is close to 1%, which indicates 500,000 to 600,000 infected individuals. However, over a half of them are not aware of such seropositivity, which contributes to virus dissemination, particularly in drug-addicted populations. Alcoholic cirrhosis induces numerous dermatologic signs well known by hepatologists. However, the frequently associated isolated or combined deficiency syndromes may be disconcerting, such as the pseudo-glucagonoma syndrome that is observed in severe zinc deficiency. The cutaneous signs observed with other types of cirrhoses are of later occurrence, except for the pruritus related to the primitive biliary cirrhosis that precedes cholestatic jaundice. In pancreatic diseases, cutaneous manifestations are common and, most of the time, indicative. Some of them are frequent but they are observed most of the time by surgeons and gastroenterologists; this is the case with the subcutaneous haemorrhage related to severe acute pancreatitis. Others, such as the panniculites and paraneoplastic syndromes, are rare but have to be detected. This is why a close collaboration between organ specialists is necessary, for the affections of the digestive tract as well as for the liver and pancreas diseases.