HEPATIC disease manifests itself not infrequently by producing changes in the skin, changes which include such well known phenomena as the sudden appearance of spider nevi, palmar erythema and gynecomastia. A considerable body of evidence exists suggesting that these changes are produced by the local action of circulating estrogens which the liver, in its damaged state, is unable to inactivate. Alternatively, these changes may occur in the presence of a healthy liver when the level of circulating estrogen is higher than that with which the liver is normally capable of dealing. Bean and his colleagues (1949)1 have recently described the appearance of palmar erythema and spider nevi in pregnant women, while the gynecomastia of puberty is thought to be due to a sudden increase of circulating estrogen which upsets the normal estrogen-androgen balance. Gynecomastia has also been described as occurring under conditions following starvation, by Jacobs (1948),2 and