THE PHENOMENA OF LEG PIGMENTATION IN CASES OF CHRONIC LIVER DISEASE

Y.A. ELGHAFFAR, M.E.ELWAHAB, S.M. SALEH, A.A.RAOUF,H.M.LIMOUNE. LIVER Institute. Dept of Med. Dep. of biochemistry - Menofeia university

The aim of this work was to study this phenomenon, its relative frequency, its relation to various forms of chronic liver disease its correlation to other features of chronic liver disease, its pathogenesis and the underlying mechanisms of its production. This study included 54 male and female patients with chronic liver disease presenting with pigmentation of skin on the dorsum of their feet. The subjects were divided into 3 groups according to the severity of skin pigmentation. Fifty male and female patients with chronic liver disease without skin pigmentation were also included in this work as a control group. Patients and controls were selected from inpatients and outpatients of the department of medical hepatology of liver institute of Menoufyia University. The study was done in the period from october 1992 to june 1995. The study included : history, clinical examination, urine and stool analysis, rectal biopsy for patients who were negative for bilharzial ova in urine and stool analysis, liver function tests, bleeding and coagulation time, total s. iron, virologic liver profile for HB cAb, HBeAg, HBeAb, HBsAb and anti HCV, ultrasonographic examination of abdomen, direct liver biopsy, and skin biopsy.

Skin pigmentation in our studied patients appeared as bilateral permanent diffuse area of hyperpigmented skin on a big part or the whole of the dorsum of the foot extending in some patients into the shaft of the leg above the ankle joint. In conclusion, it is seen that the phenomenon of pigmentation of the dorsum of the foot has significantly apositive association with : yellow color of the sclera, abdominal distention, bleeding per nose and gums, and disturbed levels of consciousness vascular spiders, and edema of lower limbs decreased size of the liver (shrunken liver), and increased size of spleen (mild splenomegaly), positive schistosomiasis(both in stool &rectal snip), increased level of total s. proteins and decreased level s . albumin, increased level of total s. iron, HCV-Ab, HBcAb. ascites, and increased diameter of the portal vein (portal hypertension) and hemosiderin, hyaline degenerative changes, and melanin of skin biopsy. Thus, we can conclude that the finding of pigmentation of the foot can be considered a confirmatory sign of cirrhosis in the presence of positive histopathology of the liver and a useful suggestive sign of cirrhosis in the absence of histopathlogy.

Source: American Association for the Study of Liver Diseases - 1996 Annual Meeting

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