ABSTRACT
The prevalence of liver disease is increasing in the UK and worldwide and assessment of hepatic function is essential before commencing any potentially hepatotoxic drug. Prescribing systemic dermatological treatment in patients with pre-existing liver disease can present challenges as many of these drugs commonly cause liver damage. Long-term methotrexate therapy is associated with development of dose dependent hepatic fibrosis and the drug is therefore contraindicated in those with underlying chronic liver disease, apart from in exceptional circumstances. In patients with chronic liver disease the majority of drugs can be used, but specific consideration should be given to dosing and monitoring. Isotretinoin is contraindicated in patients with severely impaired liver function. Clinically apparent liver injury due to acitretin is rare, but several cases have been reported. About 5% of patients develop more significantly elevated liver enzymes that usually normalize rapidly with dose reduction or drug discontinuation.
