World Liver Day is celebrated on April 19 every year to spread awareness about the importance of liver health and educate people on how to maintain a healthy liver. Liver diseases are known to develop silently with no visible symptoms until the disease has advanced. Diseases like Hepatitis A, Hepatitis B, liver cirrhosis, liver cancer, non-alcoholic fatty liver disease (NAFLD) are now affecting people more than ever before. According to an estimate by WHO, between 1990 to 2017, there has been a 100% increase in the incidence of new liver cancer cases, two-thirds of which are attributable to viral hepatitis, and 16% due to unknown causes, including NAFLD. (Also read: Fatty liver: 3 easy exercises, 6 lifestyle changes to reverse liver disease)
Liver is a crucial organ that performs numerous essential functions in the body, including detoxification of harmful substances, production of bile to aid in digestion, and regulation of metabolism. Hence, taking care of this organ is crucial to prevent liver-related diseases. Preventing or managing metabolic disorders like obesity, diabetes and high cholesterol well could prevent NAFLD risk.
“One of the most common liver diseases is fatty liver disease, which affects millions of people around the world. Fatty liver disease occurs when there is an accumulation of fat in the liver, which can cause inflammation and damage to the liver tissue in advance stages. While fatty liver disease is often asymptomatic, some signs can indicate the presence of the disease,” says Dr Amit Miglani – Director & HOD – Gastroenterology, Asian Hospital Faridabad.
“Non-alcoholic associated fatty liver disease is now a modern day non-communicable pandemic akin to Covid-19 and a major lifestyle disorder of modern age, major risk factors being sedentary lifestyle and faulty dietary practices. Unfortunately, not many symptoms or signs are seen on face, skin or eyes in the initial stages of the disease and by the time signs appear it would have already turned into advanced liver disease,” says Dr Vinit Shah, Consultant Liver Transplant Physician & Hepatologist at Ruby Hall clinic.
“Very often you won’t get any features of fatty liver on your face, eyes or skin. But we can get certain hints in some of the people. If somebody has darkening of the skin on the neck, which typically what is called as a nape of the neck, that indicates insulin resistance, and that would almost always be associated with fatty liver. Similarly, if there’s darkening of the skins, in your armpits, or in the groins, those are also indications that the person may have a fatty liver,” says Dr Akash Shukla, Director & Consultant, Department of Hepatology, Sir HN Reliance Foundation Hospital, Mumbai.
“Additionally, excessive chubbiness on the face or other parts of the body indicates that the person is likely to have fatty liver. If you get what we call as xanthelasma and xanthomas, which are whitish streaks, which are present very often around the eyes, face and some of the parts of the skin- those indicate high cholesterol, high triglyceride and would almost always be associated with fatty liver. So, if someone has these tell-tale signs, then they must investigate for sugar, cholesterol, heart disease, and fatty liver,” adds Dr Shukla.
He, however, cautions that absence of any of these does not mean absence of fatty liver disease. And therefore, anybody who has any risk factor for fatty liver like high cholesterol, high sugar, sedentary lifestyle, obesity, or a family history of fatty liver disease or consuming significant alcohol then they should investigate for presence of fatty liver.
Dr Miglani shares signs of fatty liver on skin, eyes and face
Jaundice
A medical condition known as jaundice causes the skin and eye whites to turn yellow. This happens when the liver is unable to get rid of bilirubin from the blood. When old red blood cells are broken down, bilirubin is created as a waste product. The liver breaks down bilirubin in healthy people and excretes it in the bile. Jaundice, on the other hand, develops when the liver is damaged and unable to handle bilirubin.
Spider Angiomas
Spider angiomas are small, red spider-like blood vessels that can appear on the face and neck. These are caused by an increase in oestrogen levels, which is common in people with liver disease. The liver is responsible for metabolising hormones, and when it is damaged, it can increase oestrogen levels.
Palmar erythema
Palmar erythema is a condition where the palms of the hands turn red. This can be a sign of liver disease, as it is caused by an increase in blood flow to the palms. The exact mechanism behind this is not fully understood, but it is believed to be related to the build-up of toxins in the liver.
Dark circles under the eyes
Dark circles under the eyes can be a sign of liver disease, as they are often caused by poor liver function. The liver is responsible for filtering toxins from the blood, and when it is unable to do so, it can result in a build-up of toxins in the body. This can lead to dark circles under the eyes and other symptoms such as fatigue and weakness.
Acne and other skin conditions
Acne and other skin conditions can be a sign of liver disease, as the liver is responsible for removing toxins from the body. When the liver cannot do so, it can result in a build-up of toxins in the body, leading to skin problems such as acne.
“This liver disease is considered as a silent disease. It’s a great setback because patient does not develop any symptoms and the disease advances gradually. Some people may experience pain or pressure in the middle or right side of their belly, fatigue, weakness, weight loss, loss of appetite and nausea. People with advanced liver disease may show symptoms like spider-like blood vessels, yellowing of the skin and eyes (jaundice), itching, fluid accumulation and swelling of the legs (edema), abdomen (ascites) and mental confusion. As there are no symptoms, patients need liver function test (blood test), and ultrasound for diagnosis. Fatty liver can be graded in a better way by Fibroscan,” says Dr Punit Singla, Director & HOD – Liver Transplant & HPB Surgery, Marengo Asia Hospitals Faridabad
