Chronic liver disease:

Chronic liver disease may present with jaundice, palmar erythema, spider naevi, white nails, hyperpigmentation and pruritus.

Porphyria cutanea tarda (PCT, p. 1149) is a rare genetic disorder associated with liver disease usually due to hepatic damage from excessive alcohol consumption or hepatitis C infection: 75% of cases are sporadic, 25% familial. Overall, 20% of cases have underlying hereditary haemochromatosis (p. 386). It presents clinically on exposed skin with sun-induced blisters, skin fragility, scarring, milia and hypertrichosis. Treatment of the cutaneous features is with repeated venesection and/or very low-dose chloroquine plus an avoidance of alcohol. There is anecdotal evidence that specific treatment of hepatitis C (p. 373) will also help the skin, presumably through improving liver function. All forms of PCT are at risk of hepatic carcinoma.