Cutaneous Manifestations of Liver Disease: A Narrative Review

Chronic liver disease is a major cause of morbidity and mortality. The most common extrahepatic manifestations are dermatological. The pathophysiology of these dermatological manifestations is not clear, but it is postulated that the mechanisms involved include generalized vasodilatation, hyperdynamic blood circulation, and altered estrogen metabolism. The most common cutaneous manifestations of liver disease are Terry's nails and pruritus. Terry's nails consist of leukonychia with a distal pink band and the absence of the lunula. The main differential diagnosis is Lindsay's nails. Vascular manifestations of liver disease include palmar erythema and arachnoid nevi, the latter located in the vascular territory of the superior vena cava and occurring in chronic alcohol-associated liver disease. Dermatological manifestations generally resolve with improvement or remission of liver disease, and there is no specific treatment for them. However, bile acid chelators are the first line of treatment for cholestatic pruritus. Studying dermatological manifestations of liver disease contributes to early diagnosis and treatment, potentially improving the patient's prognosis.