Hep B Blog

Got HBV? What is Your Skin Trying to Tell You?

The liver is the largest solid organ in the body, and your skin is the largest organ.  It only makes sense that the skin may be a window into what is going on inside your body and your liver.  The problem is trying to figure out what your skin is trying to tell you!

The most common skin manifestation associated with “hepatitis” is the yellowing of the skin (jaundice) and the sclera, or white part of the eye.  Jaundice  may be associated with a newly acquired or acute hepatitis B infection.  It certainly gets your attention and gets you to the door of your doctor, which is a good thing.  However, keep in mind that HBV is often asymptomatic, with few or no obvious symptoms, and jaundice is a more severe symptom of an acute HBV infection. Jaundice may also occur in those with advanced liver disease, and a decompensated liver. Jaundice is due to an accumulation of bilirubin, a yellow pigment, in the blood and tissues.  Your liver is responsible for controlling the levels of bilirubin.  If your liver is having problems performing basic, yet essential functions, yellow skin, eyes, dark urine, and itching (pruritus) may all be due to an inability to filter excess bilirubin.  Please see your doctor immediately if you experience jaundice of the skin or eyes.

It is also not uncommon for those with more advanced liver disease such as cirrhosis to have palmar erythema, which presents like red palms –especially around the base of the thumb and little finger.  Keep in mind that there may be other reasons for experiencing red palms, such as high blood pressure, pregnancy, or elevated estrogen levels. Talk to your doctor if you have concerns.

Spider nevi or spider angioma are another indicator of more serious liver disease. These are not to be confused with spider veins. It is also important to note that 10-15% of healthy adults and children have spider nevi, with no underlying disease. They range in size from 0.5 to 1 cm in diameter, with a dark center, radiating out to fine, red lines. When the center is depressed with the finger, the radiating lines disappear, and then re-appear, when the finger is lifted. Spider nevi may be caused by an increased level of estrogen in the body.  Naturally these may also appear during pregnancy, and in women using oral contraceptives. Following pregnancy and the discontinuation of contraceptives, the spider angiomas will disappear on their own. Like so many basic, but essential functions, the liver is responsible for breaking down and removing excess estrogen. Spider nevi associated with liver disease tend to be large in number and appear on the upper part of the body, face, and neck – especially on the backs of the hands and arms. Once again, it is a good idea to point out these out to your doctor.

Gianotti-Crosti Syndrome is a rash associated with HBV and EBV (Epstein Barr Virus). This rash almost always occurs in children, with 90% of kids under the age of four. The rash may last from two to eight weeks. Basically, it’s just a response to a virus, and nothing to worry about – just an indicator. Kids often have a rash for one reason or another.  If the rash is excessively itchy, talk to your pediatrician about using a topical steroid. Every parent of a child with HBV is convinced their child has some sort of HBV associated rash. (Speaking from experience…) Even the pediatric liver specialist was unsure, so she got a consult with a pediatric dermatologist.  The rash was unrelated to HBV.

Wondering about your finger nails?  There’s a condition called Terry’s Nails which is present in many of those with cirrhosis. The nail appears mostly white, similar to the appearance of “ground glass”, and possibly with a little pink strip at the top of the nail bed.  This is due to a decrease in blood flow to the nail bed and an increase in connective tissue.  Remember that your doctor will not be able to see any of this if you wear nail polish to your appointment.

How about your basic rash that is associated with hepatitis B?  Rashes are most often associated with acute hepatitis B infections, although a recurring rash may occur in those chronically infected.  Talk to people living with HBV and they’ll tell you they have occasional rashes and annoying itching, even if their doctor may tell them they do not.  Could be totally unrelated, or it could be erythematous papular lesions, or palpable purpura.  In other words, your basic red or purplish, raised, bumpy rash. It’s not easy to find specific information linking your basic rash to HBV, but when you consider how the skin is a window to your general health, it makes sense that you may see skin manifestations that reflect your immune system response to your HBV infection as it cycles through various stages, phases and flares.

If you are living with HBV, you know the importance of monitoring your HBV status and your liver health.  Annual, bi-annual, or the schedule recommended to you by your liver specialist, will keep you on top of what is going on with your HBV and any associated liver disease.  However, it is good to take notice of any changes in the skin and nails as the liver is a non-complaining organ.  Sometimes we have to look for evidence that something is going on. That being said, I feel the need to rush to a mirror and check myself out after having researched and written this blog.  The skin may be a window to our general health, but it is not always easy to figure out what it’s trying to tell us. If you have any questions, don’t try to self-diagnose. Talk to your doctor and bring any of your concerns to his attention.

Comments on this blog are closed. If you have questions about hepatitis B or this blog post, please email info@hepb.org or call 215-489-4900.

23 thoughts on “Got HBV? What is Your Skin Trying to Tell You?”

  1. We adopted a child from Vietnam with chronic Hep
    B. We want to make a donation today (12/31/11) for Hep B research. Where do we donate? HIV certainly got quick results for much research, of course it was a rapid death without meds, which Hep B is not, but Hep B is more prevalent. Please email me a site to call and donate. Thank you, Kris

    1. There is another blog about dealing with itchy skin, but if you are looking for general information about having HBV, then page through the blogs since many of them present the basics of HBV. Please see HBFs website at http://www.hepb.org for both simple and in-depth information pertaining to HBV.

  2. i am am HBSag possitive please give me instuctions for health(Present HBV DNA qty -normal(20Uml) last one year tretment in ESI (Nacharam hyd) Tab:baraclude-0.5mg.
    present health tips what!

    1. You are having an excellent response to baraclude. Please be sure to continue to take the medication daily as prescribed by your liver specialist. Abruptly stopping the use of the ant viral can result in a flare that can cause liver damage. Be sure to take care of your liver health by NOT drinking alcohol and not smoking. Maintain a healthy weight by eating a well balance diet and getting regular exercise. Eat plenty of vegetables, fruits, whole grains and limited lean meats. Avoid saturated fats, fried foods, junk foods, processed foods and too much refined sugar in sodas and sweets. Remember that everything you ingest, breathe-in or absorb through the skin is filtered by your liver.

  3. Im very jandice with the spider rash. Levels are all high i need to knoe what to ask for next. I so far have heard is fatty liver but it needs to go down. Its been momths. Please help me. Thx priscilla

    1. I would encourage you to seek medical advice to be sure your liver enzymes are within safe ranges. It sounds like you would benefit from a consult with a liver specialist to determine the cause of your symptoms. HBF has a list of liver specialists though the list is not exhaustive. http://www.hepb.org/resources/liver_specialist_directory.htm . If you do not find one locally, consider a larger hospital center or teaching or research hospital that may have a better level of expertise if you are not successful with a local specialist.

  4. I was diagnosed with hepa b 10 mons ago, my doctor told me that the virus is not yet developed. I was so sick that time and usual sickness was stomach pain. Now i am ok my told me that i need to check my blood again after 6 mons but until now i have not been to a doctor because i am out of my country. I am now suffering of terrible itchiness all over my body rashes also. I am so tired of this for 5 mons already. But i dont have any yellow skin or eyes. My question is … Is this a sign of acute or chronic hepatitis? And ilmy stomach is always bloated my no stomach pain at all. Please need an advise.. Thank u!

    1. It is hard to say. If you believe this is a new infection then it is likely due to an acute infection. However, those that are chronically infected may experience a flare that may cause symptoms like you describe. I would encourage you to see a doctor. The bloated stomach may be related to something else, and the itchiness may be due to elevated bilirubin or something else, but you should get these symptoms checked out. I would agree with your doctor that you need to be retested for hepatitis B. If you continue to test positive after 6 months then you are considered chronically infected. If you learn you are chronically infected then you need to see a liver specialist to learn more.

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  6. Tested positive to acute hepatitis b 5 months ago, but no medication was given to me just ask to wait for sometime. Recently had pillion on on d back of my palm and legs any relationship to d Hbv and what do I need to do

    1. Hello: Medical guidelines recommend treatment only if you have a high viral load and signs of liver damage, indicated through a blood test. If you were newly infected with hepatitis B, it can take up to six months for our immune systems to get rid of the infection. Please eat healthy foods and avoid alcohol and cigarettes. Return to your doctor to get retested, and if you are experiencing a medical condition please see your doctor, it may be from another medical condition other than hepatitis B. Hepatitis B usually does not cause any skin problems. Good luck.

  7. A friend has developed an acute rash, with no itching involved, over his chest, shoulder, arms underarms, calves but little to no rash on his stomach, thighs (front and back) a’s well as the back of his calves. His face is fire engine red and the palms of his are unbelievably red and peeling like I have never seen before. Tonight I believe his eyes have a yellowish tinge to them. His doctor’s have taken a skin biopsy which we are waiting for the results. He is on Predisone and 2 different kinds of cream to help with the dryness, etc. Can you help direct us on what should be done next and if we need to push this into the emergency stage? I’m terrified!

    1. Hello: Encourage your friend to return to the doctor and mention the yellowish tinge to his eyes. Generally hepatitis B does not cause such extensive skin irritation. If there is a chance he is hepatitis B-infected, the predisone can weaken his immune system. Please have him consult with his doctor. Good luck.

  8. Hello doctors…..
    for almost 2years i have this symptoms that bothered me always…….i have some rashes in my both arms and sometimes in the neck,joint pain in my knees,itchiness in the neck, muscle pain in my back,flaky skin in.my both arms that keeps on appearing….fatigue feeling…i have changes my taste and my tongue have like georaphic toungue……..and i have abdominal pain but not always…..do you think i m hbv carrer?…..i thought it is hiv so i got an hiv test but im negative…….please advise me for this bothered me so much…..yhank you…..

    1. Hello: Hepatitis B does not normally cause the skin rashes and joint pain that you have described, which is why it’s called a silent infection. But to be sure, please talk to your doctor about your symptoms and also get tested for hepatitis B. If you find you are not infected, I encourage you to get vaccinated against hepatitis B so you do not have to worry about this liver infection. Good luck.

  9. I was diagnosed with acute hep b in August of this year (2016). I am still in the waiting phase and should know by January or February whether or not I am chronic. In the beginning (August), the only symptom I experienced was severe joint pain. It’s gotten much better, however, in the past 2 months I have experience other strange symptoms, including Raynaud’s condition, abdominal pain, pains all around my stomach, sides and back, nausea, high blood pressure, high pulse (in the 80s and 90s), pains in my feet, calf and back of thigh, rash on my torso. I ended up going to the emergency room last week because I felt so nauseous that I couldn’t eat and my pulse was at 100. I can’t seem to get any help from my doctors or the folks at the ER (they discharged me saying they THINK all of this is related to my hep b). Are these symptoms typical of someone going through acute hep b? Why are they happening now and not at the beginning? My liver enzymes are almost back to normal, however, my sedrate and C-reactive protein numbers continue to increase significantly which indicate inflammation. It seems like a disconnect to me that my liver enzymes are improving but my inflammation is getting worse. My docs can’t seem to explain this to me very clearly. Any help would be appreciated. My main concerns as far as my new symptoms go are the high blood pressure and high pulse. Could this be related to the hep b? Thanks for listening.

    1. Hello: The combination of symptoms you describe are not often linked to hepatitis B. And, as you point out, your ALT numbers appear to rule out liver damage. Do you have a primary care provider you can see who can refer you to a specialist? Please see a doctor to find out what is causing these symptoms. good luck.

  10. I was diagnosed of Hep B in October 2016, I went for another test to confirm if this is true or some kind of mix-up but to my amazement it came out positive. My viral load result came out on the 30th of Dec 2016 and the following are the results;
    Viral load=1080iu/ml
    HbeAg = Negative
    HBeAb = Positive.
    Pls tell me if this is still acute or chronic hep B

    1. Hello: It takes up to six months of testing to determine if you have acute or chronic hepatitis B. You have been tested for only two to three months. I’m afraid you will have to wait until six months have passed from your first hepatitis B test to know for sure if you have chronic or acute hepatitis B. However, it is a good sign for your overall health that your viral load is fairly low and you have cleared the “e” antigen and now test positive for the hepatitis B “e” antibody (HBeAb). Good luck.

  11. Hello … I had the following when I did my test and can someone let me know if it is acute or chronic
    HBsAg positive
    HBsAb negative
    HBeAg negative
    HBeAb negative
    HBcAb negative

    1. Hello: When you test positive for the hepatitis B surface antigen (HBsAG), it means you are currently infected with hepatitis B. Most healthy adults who are infected are able to get rid of the virus on their own within six months. This is called an acute infection.
      However, if you continue to test positive for HBsAg for longer than six months, it is considered a chronic infection. It means you were probably infected at birth or during early childhood, when your immature immune system could not fight it.
      Knowing whether your hepatitis B is acute or chronic will help you and your doctor determine your next steps. Please get tested again in six months to find out if it’s chronic or acute. If you are unsure of what your blood test results mean, please visit: http://www.hepb.org/prevention-and-diagnosis/diagnosis/hbv-blood-tests/
      And, if you continue to test positive for HBsAg, please have your doctor conduct liver function tests (including for the liver enzyme ALT/SGPT) and do a liver ultrasound to check for any liver damage.
      Good luck.

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