Klinische Wochenschrift

, Volume 66, Issue 7, pp 298–302 | Cite as

Cutaneous spider Nevi in liver cirrhosis: Capillary microscopical and hormonal investigations

  • M. Pirovino
  • R. Linder
  • Ch. Boss
  • H. P. Köchli
  • F. Mahler


Nailfold capillary microscopical and hormonal investigations were carried out in 25 patients with cirrhosis of the liver and in 20 age-and sex-matched controls. Several structural and functional capillary microscopical parameters were significantly different between the group of cirrhotics as a whole and the controls; no capillaroscopic feature helped to distinguish cirrhotics with spiders from those without. Serum estradiol and total testosterone were comparable in cirrhotics and controls; free serum testosterone was reduced in male cirrhotics, particularly in cirrhotics with spider nevi. The estradiol/free testosterone ratio was highest in male cirrhotics with spiders. Cirrhosis, thus, leads to both structural and functional effects on the cutaneous capillary system whether or not spider nevi are present. The presence of spider nevi is accompanied by an increased serum estradiol/free testosterone ratio in male cirrhotics. It remains to be determined whether the hormonal alterations described do indeed play a role in spider nevi formation.

Key words

Spider nevi Liver cirrhosis Microcirculation Capillary microscopy Sex hormones 


BSP retention

bromsulphthalein retention


hepatitis B surface antigen


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  1. 1.
    Baker HWG, Burger HG, de Kretser DM, Dulmanis A, Hudson B, O'Connor S, Paulsen CA, Purcell N, Rennie GC, Seah CS, Taft HP, Wang C (1976) A study of the endocrine manifestations of hepatic cirrhosis. Q J Med 45:145–178Google Scholar
  2. 2.
    Bean WB (1945) The cutaneous arterial spider: a survey. Medicine 24:243–331Google Scholar
  3. 3.
    Bean WB (1958) Vascular spiders and related lesions of the skin. Charles C. Thomas, Springfield, IllGoogle Scholar
  4. 4.
    Bean WB, Cogswell R, Dexter M, Embick JF (1949) Vascular changes of the skin in pregnancy. Surg Gynec Obstet 88:739–752Google Scholar
  5. 5.
    Berthelot P, Walker JG, Sherlock S, Reid L (1966) Arterial changes in the lungs in cirrhosis of the liver — lung spider nevi. N Engl J Med 274:291–298Google Scholar
  6. 6.
    Bollinger A, Schlumpf M (1976) Finger blood flow in healthy subjects of different age and sex and in patients with primary Raynaud's disease. Acta Chir Sand [Suppl 465]:42–47Google Scholar
  7. 7.
    Brick IB, Palmer ED (1954) Esophageal varices and vascular spiders (nevi araneosi) in cirrhosis of the liver. JAMA 255:8–10Google Scholar
  8. 8.
    Chopra IJ, Tulchinsky D, Greenway FL (1973) Estrogenandrogen imbalance in hepatic cirrhosis. Ann Intern Med 79:198–203Google Scholar
  9. 9.
    Dohan FC, Richardson EM, Bluemle JR, György P (1952) Hormone excretion in liver disease. J Clin Invest 31:481–498Google Scholar
  10. 10.
    Folkman J (1986) How is blood vessel growth regulated in normal and neoplastic tissue? Cancer Res 46:467–473Google Scholar
  11. 11.
    Lester R, Eagon PK, Van Thiel DH (1979) Feminization of the alcoholic: the estrogen/testosterone ratio. Gastroenterology 76:415–417Google Scholar
  12. 12.
    Mahler F, Saner H, Annaheim M, Linder HR (1986) Capillaroscopic examination of erythrocyte flow velocity in patients with Raynaud's syndrome by means of a local cold exposure test. In: Prog Appl Microcirc 11: Techniques in clinical capillary microscopy. Karger, Basel, pp 47–59Google Scholar
  13. 13.
    Mahler F, Fuchs C, Zürcher S (1987) Nailfold capillary loop enlargement in diabetic patients. 4th World Congress for Microcirculation, Tokyo. Elsevier Science Publ, Amsterdam (in press)Google Scholar
  14. 14.
    Maricq HR (1970) “Wide-field” photography of nailfold capillary bed and a scale of plexus visualisation scores. Microsvasc Res 2:335–340Google Scholar
  15. 15.
    Maricq HR (1986) Comparison of qualitative and semiquantitative estimates of nailfold capillary abnormalities in scleroderma spectrum disorders. Microvasc Res 32:271–276Google Scholar
  16. 16.
    Martini GA (1955) Über Gefäßveränderungen der Haut bei Leberkranken. Z Klin Med 153:470–526Google Scholar
  17. 17.
    Martini GA, Hagemann JE (1956) Über Fingernagelveränderungen bei Lebercirrhose als Folge veränderter peripherer Durchblutung. Klin Wochenschr 34:25–31Google Scholar
  18. 18.
    Nagasue N, Ogawa Y, Yukaya H, Ohta N, Ito A (1985) Serum levels of estrogens and testosterone in cirrhotic men with and without hepatocellular carcinoma. Gastroenterology 88:768–772Google Scholar
  19. 19.
    Tooke JE (1986) Microvascular hemodynamics in diabetes mellitus. Clin Science 70:119–125Google Scholar
  20. 20.
    Vallee BL, Riordan JF, Lobb RR, Higachi N, Fett JW, Crossley G, Buhler R, Budzik G, Breddam K, Bethune JL, Alderman EM (1985) Tumor-derived angiogenesis factors from rat Walker 256 carcinoma: an experimental investigation and review. Experientia 41:1–15Google Scholar
  21. 21.
    Zürcher S (1986) Quantitative videomikroskopische Parameter von Nagelfalzkapillaren bei Bindegewebserkrankungen, Diabetes mellitus and funktionellen Störungen im Vergleich zu Gesunden. Thesis, University of Berne, SwitzerlandGoogle Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • M. Pirovino
    • 1
  • R. Linder
    • 2
  • Ch. Boss
    • 2
  • H. P. Köchli
    • 3
  • F. Mahler
    • 2
  1. 1.Medizinische UniversitätsklinikSchweiz
  2. 2.Abteilung für Internistische AngiologieSchweiz
  3. 3.Chemisches Zentrallabor, Inselspital BernSchweiz

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