Visual indicators of a fatty liver, showcased through photographs and additional insights
Nonalcoholic fatty liver disease (NAFLD) is the most common type of chronic liver disease, and if left untreated, it can progress to a more severe form known as nonalcoholic steatohepatitis (NASH), where the liver is inflamed. Here are some facial signs that may indicate NASH progression:
Jaundice
One of the primary recognizable facial signs of NAFLD progressing to NASH is jaundice, a yellowing of the skin and eyes. This occurs when the liver is not functioning properly, causing a buildup of waste material known as bilirubin. Although it may be harder to notice in black or brown skin, the white parts of the eyes will still appear yellow[1][2][4].
Darkening or Hyperpigmentation of the Skin
Some patients with NASH may develop patches of darker skin, often in areas prone to friction. While this is not specific to NASH, it may be associated with liver dysfunction and metabolic syndrome[1].
Red Palms (Palmar Erythema)
This may be visible on the hands but can sometimes extend to the wrists and lower forearms, reflecting changes in blood flow and hormone metabolism due to liver damage[1].
Early stages of NAFLD are typically asymptomatic without obvious facial signs. Visible facial indicators such as jaundice generally emerge only in the later stages when inflammation and liver cell damage cause significant liver dysfunction.
Acanthosis Nigricans
Acanthosis nigricans, a darkening of the skin folds, such as those on the neck, can happen due to insulin resistance, which can occur when chronic liver disease damages the liver[3].
Skin Irritation and Dermatitis
NASH can also cause dermatitis, or skin irritation, including in the skin on the face. A dry, itchy rash with small bumps may develop due to a zinc deficiency caused by chronic liver diseases[2].
Spider Veins
Multiple spider angiomas may be a sign of chronic liver disease, such as NASH. Spider veins are thread-like lesions that occur when capillaries just under the skin's surface dilate[2].
Managing NAFLD and NASH
Making lifestyle changes, such as following a healthy, balanced diet, exercising regularly, and avoiding alcohol, can help manage NAFLD and NASH[5]. A doctor can recommend treatments and lifestyle changes for fatty liver disease and offer medications to help manage any skin problems that arise. Facial symptoms of NAFLD, such as spider veins, acanthosis nigricans, and others, may reduce when a person makes lifestyle changes to address the disease.
It is essential to note that having rosacea does not guarantee the presence of fatty liver disease. If you notice any symptoms of chronic liver disease on your face or skin, contact a doctor immediately. Early diagnosis and treatment can significantly improve the prognosis of NAFLD and NASH.
[1] Mayo Clinic. (2021). Nonalcoholic fatty liver disease. https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20373453
[2] Cleveland Clinic. (2021). Nonalcoholic fatty liver disease (NAFLD). https://my.clevelandclinic.org/health/diseases/16709-nonalcoholic-fatty-liver-disease-nafld
[3] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Acanthosis Nigricans. https://www.niddk.nih.gov/health-information/skin-and-hair/acanthosis-nigricans
[4] American Liver Foundation. (2021). NAFLD & NASH. https://www.liverfoundation.org/for-patients/about-the-liver/disease-listing/nonalcoholic-fatty-liver-disease-nash/
[5] National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Preventing Nonalcoholic Fatty Liver Disease (NAFLD). https://www.niddk.nih.gov/health-information/liver-disease/nonalcoholic-fatty-liver-disease-nafld/prevention
- Aq: In some cases, acanthosis nigricans, a darkening of skin folds, can be a sign of insulin resistance, which may occur due to type 2 diabetes.
- Zinc: Chronic liver diseases can cause a zinc deficiency, leading to skin irritation and dermatitis, including on the face.
- Paxlovid: Paxlovid is an antiviral medication used for treating COVID-19, but it should be used with caution for individuals with chronic liver diseases, such as nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH).
- Retargeting: For workplace-wellness programs, retargeting digital ads focusing on health and wellness, such as fitness and exercise, diabetes management, and mental health resources, may be beneficial for employees with chronic diseases like NAFLD and NASH, who may be at risk for depression and other mental health issues.
- Spiderveins: Spider veins, thread-like lesions on the skin, may be a sign of chronic liver disease, such as NAFLD or NASH.
- Migraine: Migraines are common in individuals with obesity, type 2 diabetes, and other chronic diseases, including chronic kidney disease and COPD (chronic obstructive pulmonary disease).
- Contextual: When targeting individuals with chronic diseases like NAFLD or NASH for workplace-wellness programs, it is essential to understand the contextual factors, such as their specific medical conditions, mental health, skin conditions, respiratory conditions, and eye health.
- Varicoseveins: Varicose veins are enlarged, swollen veins that can occur in the legs and may be more common in individuals with NAFLD or NASH.
- Alzheimers: Alzheimer's disease is a degenerative brain disorder that may be more common in individuals with diabetes, including type 2 diabetes.
- Depression: Depression is a mental health condition that may be associated with chronic diseases, such as diabetes, chronic kidney disease, and obesity, as well as liver diseases, such as NAFLD or NASH.
- COPD: Chronic obstructive pulmonary disease (COPD) is a respiratory condition that may be more common in individuals with diabetes, including type 2 diabetes.
- Type: Type 2 diabetes places individuals at an increased risk for chronic kidney disease and various other chronic diseases, such as Alzheimer's disease, depression, and NAFLD or NASH.
- Predictive: A predictive model based on various factors, such as age, sex, body mass index, and certain medications, may help in identifying individuals at an increased risk for developing NAFLD or NASH.
- Rosacea: Although it is not a direct sign of fatty liver disease, rosacea, a skin condition characterized by redness and pimples on the face, may be more prevalent in individuals with obesity, type 2 diabetes, and other chronic conditions, like NAFLD and NASH.
- Obesity: Obesity and type 2 diabetes increase the risk of developing various chronic diseases, such as NAFLD or NASH, chronic kidney disease, Alzheimer's disease, and depression.
- Science: Recent research has highlighted the importance of addressing chronic diseases, such as NAFLD, NASH, and type 2 diabetes, through a comprehensive approach that considers factors like science, nutrition, skin care, fitness and exercise, and mental health to optimize workplace-wellness and overall health and wellness.
