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

Abstract

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 the increased prevalence of metabolic syndrome and excess alcohol use in those with psoriasis and hidradenitis suppurativa, in addition to the use of potentially hepatotoxic drugs such as methotrexate.

In isolation, standard liver function tests lack sensitivity to detect advanced fibrosis and cirrhosis and are of limited value. Traditionally diagnosis has relied upon liver biopsy, which remains the gold standard but is both costly and invasive. There have been several recent advances in the development of non-invasive 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 and magnetic resonance. This review summarises current and future non-invasive diagnostic techniques for evaluation of liver fibrosis.

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