A DISTINCTIVE VESICULOPUSTULAR ERUPTION ASSOCIATED WITH HEPATOBILIARYDISEASE

Background Cutaneous manifestations of hepatobiliary disease may be a clue to the clinical diagnosis. We encountered a form of vesiculopustu lar eruption in five patients with hepatobiliary disease. A similar er uption has been described in the setting of ulcerative colitis, and ha s received the designation of vesiculopustular pyoderma gangrenosum. M ethods Skin biopsy specimens were examined by conventional histopathol ogic methods and, in three cases, fresh tissue was available for direc t immunofluorescence examination. A diagnosis of hepatobiliary disease was known in three of the patients and in the other two it was establ ished by the skin biopsies. Results All skin biopsies of the five pati ents showed a neutrophilic dermatosis that had two morphologies. One w as characterised by superficial neutrophilic dermolysis with subepider mal bulla formation and the other by a nonulcerating destructive suppu rative folliculitis and perifollicular neutrophilic dermolysis. Both w ere frequently accompanied by a neutrophilic and lymphotic eccrine hid radermitis and a Sweet's syndrome-like vascular reaction. The lesions were held to represent a novel vesiculopustular eruption with features reminiscent of pyoderma gangrenosum Conclusions We propose the term v esiculopustular eruption of hepatobiliary disease for this distinctive clinicopathologic entity, which bears a strong histologic resemblance to pyoderma gangrenosum. Patients with a known hepatopathy who presen t with necrotizing vesicles and pustules may have such an eruption. Th e onset may be the first clue to or herald an exacerbation of underlyi ng liver disease.