PREVALENCE OF DERMATOLOGIC AND OPHTHALMIC MANIFESTATIONS IN HEPATIC AND OBSTETRIC CHOLESTATIC DISORDERS: A SYSTEMATIC REVIEW OF CROSS-SECTIONAL DATA

Abstract

Hepatic cholestatic disorders—including intrahepatic cholestasis of pregnancy (ICP), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC)—represent a spectrum of diseases characterized by bile-flow impairment and accumulation of toxic bile acids. These conditions often manifest through extrahepatic systems, notably the skin and eyes. Dermatologic and ophthalmic signs may precede biochemical changes and provide non-invasive clinical indicators of hepatic dysfunction and obstetric risk.

Objective: To systematically review and summarize the prevalence and spectrum of dermatologic and ophthalmic manifestations among patients with hepatic and obstetric cholestatic disorders, emphasizing sex-specific and pregnancy-related variations.

Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted for studies published from January 2010 to October 2025. Cross-sectional or observational studies reporting prevalence data for dermatologic (e.g., pruritus, jaundice, spider angiomas) and ophthalmic (e.g., scleral icterus, dry eye) findings in adults or pregnant women with hepatic or obstetric cholestatic disorders were included. The Joanna Briggs Institute (JBI) checklist was used to assess risk of bias. Data were synthesized narratively and, when homogeneous, pooled using random-effects models.

Results: Twenty-six studies (n = 8,942) met inclusion criteria: 6,214 patients with chronic hepatic cholestasis (PBC, PSC, drug-induced, or viral) and 2,728 with ICP. Dermatologic manifestations were highly prevalent—pruritus 64 %, jaundice 42 %, spider angiomas 33 %, palmar erythema 21 %, xanthelasma 9 %. Ophthalmic manifestations included scleral icterus 48 %, conjunctival pallor 22 %, and dry eye 18–32 %. Pruritus intensity correlated with serum bile acids (r = 0.62, p < 0.001). ICP studies demonstrated resolution of symptoms within 2–4 weeks postpartum. Heterogeneity (I² = 74 %) reflected variable diagnostic criteria and biochemical thresholds.

Conclusion: Dermatologic and ophthalmic signs are frequent and clinically meaningful across hepatic and obstetric cholestatic disorders. Their presence correlates with disease severity and, in pregnancy, may predict adverse perinatal outcomes. Incorporating routine dermatologic and ocular assessments into obstetric hepatology practice may improve early recognition and multidisciplinary care.