Diagnosing liver fibrosis: a narrative review of current literature for dermatologists

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State-of-the art techniques for evaluating liver fibrosis

Expert opinion

Liver fibrosis results from chronic liver damage due to the excessive accumulation of extracellular matrix proteins, including collagen, that occurs in most types of chronic liver diseases. The main causes of liver fibrosis in industrialized countries include chronic HCV infection, alcohol abuse, non-alcoholic fatty liver disease (NAFLD), and steatohepatitis (NASH). Some drugs can also induce liver fibrosis.
Methotrexate (MTX) is an antineoplastic and immunosuppressive agent widely used in cancer, rheumatoid arthritis, and psoriasis therapies. Long-term methotrexate therapy has been associated with the development of chronic liver injury, progressive fibrosis, cirrhosis, and portal hypertension.
Liver fibrosis is a long and complex biological process. Activated hepatic stellate cells, portal fibroblasts, and myofibroblasts have been identified as major collagen-producing cells in the injured liver. These cells are activated by fibrogenic cytokines such as TGF-β1, angiotensin II, and leptin. Emerging antifibrotic therapies are aimed at inhibiting the accumulation of fibrogenic cells and/or preventing the accumulation of extracellular matrix proteins.
In most cases, no symptoms are observed in the early stages of NASH. Most people who have NASH feel fine and don’t know they have it. Symptoms start to appear as NASH progresses and liver damage worsens. The mechanism leading to sever liver damage is triggered.
It is of critical importance to diagnose the state of the disease as early as possible and monitor its progression.
In this review, Jonathan Potts takes a detailed inventory of all techniques available for diagnosing liver fibrosis in patients treated for chronic skin diseases.
Perhaps you are not a dermatologist, but are interested in the cutting-edge techniques to assess liver fibrosis and monitor its progression?
Discover the panel of today’s methods and technologies. Learn more about the latest liver fibrosis markers that will be included in the clinical guidelines. Always stay one step ahead!


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.


British Journal of Dermatology. 2017 Sep;177(3):637-644

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