Background: Cirrhosis   often is  a silent  disease Clinical   symptoms at presentation  may include jaundice of the eyes or skin,  pruritus, gastrointestinal   bleeding, coagulopathy, increasing  abdominal girth, and mental status changes.  Pruritus may be the presenting symptom,  arising years before any other  classic  clinical  and laboratory  markers  of hepatic dysfunction.   This study examines the clinical,   laboratory  and histopathological    changes

in the skins of cirrhotic patients with pruritus    in  comparison  with cirrhotic   patients

without  pruritus  and healthy   control  skins  .

Patients and Methods; To evaluate  histopathological   changes   in cirrhotic   patients with pruritus, cirrhotic   patients   without pruritus   and corresponding   healthy  (control). skin biopsies  (20 specimens   each) using   hematoxylin   and eosin stain  and to study mast cell density   using  gimesa stain.

Results: In the skin  biopsy   specimens   of the cirrhotic   patients  with pruritus  we found several  histological   changes  including:  epidermal  hyperplasia   (acanthosis)   ,vascular ectasia(dilated   dermal   blood   vessels),  hypertrophied   dermal  nerve endings,  mixed inflammatory  cellular  infilterate  and lymphocytic  vasculopathy  (swelling  of the endothelial  cell lining  of the blood  vessels without  fibrinoid necrosis,   leucocytoclasia  or extravasation  of red blood cells).  Evaluation   of mast cell  count in Girnesa  stained  skin sections   revealed  an  increased numbers of these cells  in the  group of cirrhotic   patients with  pruritus  ( N=5- l  0).  The cells  noted in perivascular,  perineural   and  interstitial distribution   (between collagen   bundles).

Conclusions;   We report,  for the first time,  some  histopathologial      changes   in  the skins  of cirrhotic  patients  with  pruritus  in  comparison  with  cirrhotic   patients without   pruritus  and healthy  control  skins .

Introduction:

Cirrhosis   refers to a progressive,  diffuse,  fibrosing  and  nodular   condition   that disrupts the entire  normal  architecture  of the liver  I i ).In developed  countries,  the leading causes of cirrhosis   are HCV  infection,  alcohol   misuse,   and  nonalcoholic    fatty liver  disease   (2). Hepatitis  B viral  infection  is  the most common  cause of cirrhosis in  developing   countries