Frequency and Clinical Predictors of Cutaneous Manifestations in Patients With Chronic Liver Disease

Chronic liver disease (CLD) is often accompanied by a variety of skin conditions, which may be related to the severity of the disease and to other systemic involvement. This study aimed to determine the prevalence and evaluate demographic and clinical predictors of cutaneous manifestations in patients with CLD.

The study was a hospital-based analytical cross-sectional study conducted at the Department of Gastroenterology and Hepatology, Lady Reading Hospital (Peshawar, PAK), from February 2025 to February 2026. Non-probability consecutive sampling was used to recruit a total of 238 patients with CLD. A structured pro forma was used to collect detailed demographic, clinical, dermatological, and laboratory data. The severity of CLD was assessed using the Child-Pugh classification, and cutaneous manifestations were diagnosed through standardized clinical dermatological examination. Associations between variables were assessed using the chi-square test, and independent predictors were identified using multivariable logistic regression analysis. Variables were selected based on univariate analysis and clinical relevance.

Cutaneous manifestations were present in 196 (82.35%) patients and absent in 42 (17.65%). The most common findings included pruritus in 154 (64.71%), jaundice in 147 (61.76%), xerosis in 118 (49.58%), and palmar erythema in 96 (40.34%) patients. Severity-wise, manifestations were significantly higher in Child-Pugh class C (91.78%) compared to class B (86.54%) and class A (63.93%) (p <0.001). Independent predictors of cutaneous manifestations included Child-Pugh class C (adjusted odds ratio (AOR) 3.95), hepatitis C virus infection (AOR 2.87), diabetes mellitus (AOR 2.11), male gender (AOR 1.72), and disease duration greater than five years (AOR 2.36).

Cutaneous manifestations are highly prevalent in patients with CLD and are significantly associated with disease severity and important clinical risk factors. These findings should be interpreted as associations rather than causal relationships. Future studies should use longitudinal multicenter designs to better establish temporal relationships and causal pathways between CLD progression and cutaneous manifestations. In clinical practice, routine dermatological examination should be incorporated into the assessment of CLD patients as a simple, low-cost tool to aid early recognition of disease severity and systemic involvement.