Itching: Liver disease progression and other causes (2023)

Itchy skin, or pruritis, can sometimes indicate an underlying condition, such as liver disease. However, not everyone with liver disease experiences itching, and the specific causes of this itching are unknown.

This article looks at the possible causes of itching in people with liver disease and other possible causes of itching. We also cover how to treat it and when to speak with a doctor.

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The liver is the body’s largest solid organ. It breaks down fats, detoxifies the body, produces cholesterol and proteins, and stores vitamins.

The Centers for Disease Control and Prevention (CDC) state that 4.5 million adults in the United States have a diagnosis of liver disease.

Some types of liver disease that involve itching include:

  • primary biliary cirrhosis (PBC)
  • intrahepatic cholestasis of pregnancy
  • chronic hepatitis B and C
  • familial intrahepatic cholestasis
  • Alagille syndrome
  • primary sclerosing cholangitis (PSC)
  • cancer of the head of the pancreas
  • biliary obstructive disease

Itching is also more common with autoimmune liver diseases, such as PSC and PBC, and overall with intrahepatic liver diseases, which refers to conditions affecting structures inside the liver.

In contrast, extrahepatic liver diseases affect the liver but occur outside the organ. Some of these can involve itching, such as PSC and cancer of the head of the pancreas.

Pruritis is less common with alcohol-induced liver diseases and nonalcoholic fatty liver disease.

Causes

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Scientists do not know precisely why itching occurs with liver disease. Below are some theories that scientists have been investigating.

Bile salts

The authors of a 2015 research article suggest that liver disease can increase the levels of bile salts, which then gather under the skin, resulting in pruritis. The body makes bile salts from bile acids.

However, itching does not affect everyone with liver disease and high levels of bile salt, and scientists have not confirmed a link between the severity of pruritis and bile salt concentration.

Other research suggests that unusual levels of bilirubin stimulate peripheral itch sensory neurons. Bilirubin is a pigment of bile. People with liver disease often have high levels of bilirubin.

Other naturally occurring chemicals

Other substances that occur naturally in the body may trigger pruritus, according to some research.

They include:

  • histamine
  • opioids
  • serotonin
  • female sex hormones

Histamine levels tend to be higher in people with cholestatic pruritus, although itching does not appear to be worse in individuals with higher histamine levels.

Some believe that serotonin can alter a person’s itch perception, resulting in increased itching. Some people have found that taking serotonin reuptake inhibitors helps manage pruritus. Those who took opioid antagonists also reported that their itching improved.

Sensitive skin cells

In 2021, some researchers found evidence that itching with PBC might involve a nerve reaction in keratinocytes, cells in the skin’s outer layer.

People with PBC have high levels of a lipid (fat) known as lysophosphatidylcholine (LPC) circulating in their blood. When the scientists injected the skin of mice with this substance, they noted an increase in itching.

They concluded that as LPC reaches the skin through circulation, it may trigger a reaction that leads to itching.

Many other causes of itchy skin do not relate to the liver.

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These include:

  • atopic eczema
  • psoriasis
  • dry skin
  • heat rash
  • allergies
  • hives
  • fungal infections, such as thrush, ringworm, and athlete’s foot
  • parasitic infections, for instance, scabies and lice
  • hormonal changes, for example, during pregnancy and around menopause
  • other health conditions, such as thyroid or kidney problems

Scientists do not know why itching occurs with liver disease. They believe some chemicals in the body may play a role, but there is no apparent link between the levels of these chemicals and the severity of itching.

This suggests that, as far as doctors know, itching does not indicate that liver disease is worsening, at least for some liver conditions.

Theories to explain why the itching intensity varies focus on the nature of the nerve pathways that carry the feeling or perception of itching.

In one theory, the same pathways carry both itch and pain stimuli. In other, they are separate. In this case, genetic, dietary, and environmental factors may play a role.

Researchers have investigated various possible treatments for itching due to liver disease. However, there is no certain way of treating it, as doctors do not yet know why it occurs.

Prescription drugs that may help manage symptoms include:

  • bile acid sequestrants, such as cholestyramine (Prevalite)
  • bile acids that help the body remove other bile acids, for instance, ursodeoxycholic acid
  • rifampicin (Rifadin), an antibiotic
  • opioid inhibitors, such as naloxone (Narcan) and naltrexone (Vivitrol)
  • a serotonin receptor antagonist called sertraline (Zoloft)

However, some of these treatments can have adverse effects. With this in mind, scientists continue to investigate other options.

Another treatment possibility may be antihistamines, although an older review from 2010 concluded that topical antihistamines were ineffective.

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Home remedies

Here are some other tips for reducing symptoms:

  • applying skin moisturizers
  • avoiding irritants, such as perfumed cosmetics
  • taking cool baths
  • applying a cold, wet cloth to affected areas
  • avoiding hot environments
  • wearing loose-fitting clothing
  • avoiding scratching where possible
  • wearing gloves when sleeping to avoid scratching
  • using an aqueous cream with 1% menthol to soothe and cool the skin

Itchy skin is typically harmless, but it can sometimes indicate liver disease.

Often, liver disease does not have any symptoms in the early stages. However, a person should speak with a doctor if they experience:

  • yellowing of the whites of the eyes, a sign of jaundice
  • fatigue and weakness
  • a loss of appetite, which may lead to weight loss
  • a loss of libido, or sex drive
  • nausea or vomiting

A person may also wish to seek medical advice if itching:

  • is severe or persistent
  • affects the whole body
  • leads to excessive scratching, resulting in secondary skin lesions or infection
  • occurs on the soles of the feet and palms of the hands
  • disturbs their sleep
  • affects their quality of life

People with an existing diagnosis of liver disease who experience itching may wish to seek medical advice. However, it does not necessarily mean that liver disease is worsening.

Itching is not unusual during pregnancy. It can result from hormonal changes or as the skin stretches. But, it can also result from a liver condition called intrahepatic cholestasis of pregnancy (ICP).

With ICP, bile acids do not flow properly, and they build up in the body, causing itching.

Symptoms of ICP include:

  • itching, especially on the palms of the hands and soles of the feet
  • dark urine
  • jaundice
  • pale stools

ICP typically disappears after delivery.

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During pregnancy, the following may help manage itching:

  • wearing loose-fitting clothes
  • wearing cotton clothes
  • taking cool baths
  • avoiding using perfumes
  • moisturizing
  • avoiding spicy food, caffeine, and alcohol

Here are some common questions and answers about liver disease and itching.

Where does itching occur with liver disease?

It may occur anywhere in the body but notably in the palms of the hands and soles of the feet.

What kind of liver disease causes itching?

Itching is common in autoimmune liver diseases, such as primary biliary cirrhosis, primary sclerosing cholangitis, and obstructive biliary disease. It also occurs with cancer of the head of the pancreas, hepatitis, and drug-induced liver disease. However, it is less common with alcohol-induced liver disease and nonalcoholic fatty liver disease.

What are the signs that liver disease is getting worse?

Itching is not necessarily a sign of liver disease getting worse, but it may occur. As damage progresses, a person may experience confusion, easy bruising or bleeding, swelling in the abdomen, legs, and feet, and signs of jaundice, such as yellowing of the whites of the eyes.

There are many causes of pruritus, including some types of liver disease.

Experts do not know precisely why itching occurs with liver disease, although several theories exist. It is not a sign that liver disease is getting worse.

If a person has itching lasting more than 6 weeks, they should speak with a doctor.

FAQs

At what stage of liver disease does itching occur? ›

Pruritus can develop at any stage of cholestatic liver disease and it should be particularly noted that severity of cholestatic itch is independent of the duration, biochemical severity, and histological stage of the underlying liver disease.

Can liver problems cause itching all over? ›

Bile Salts- Those with liver disease may have higher levels of bile salt building up under the skin, which may cause itching.

What liver problems cause itchy skin? ›

Itching is common in autoimmune liver diseases, such as primary biliary cirrhosis, primary sclerosing cholangitis, and obstructive biliary disease. It also occurs with cancer of the head of the pancreas, hepatitis, and drug-induced liver disease.

When should I be worried about itching? ›

See your doctor or a skin disease specialist (dermatologist) if the itching: Lasts more than two weeks and doesn't improve with self-care measures. Is severe and distracts you from your daily routines or prevents you from sleeping. Comes on suddenly and can't be easily explained.

What are the signs of advanced liver disease? ›

Advanced symptoms
  • yellowing of the skin or whites of the eyes (jaundice)
  • swelling in the legs, ankles and feet caused by a build-up of fluid (oedema)
  • swelling in your abdomen caused by a build-up of fluid known as ascites.
  • a high temperature and shivering attacks.
  • very itchy skin.
  • hair loss.

How do you stop liver itching? ›

For more severe and generalised itch associated with cholestasis, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) recommend step-wise treatment using colestyramine (cholestyramine), rifampicin (rifampin), naltrexone and sertraline.

What level of bilirubin causes itching? ›

At highly elevated levels however, such as in cutaneous jaundice (>5 mg/dL, >85.5 μM bilirubin), it is associated with pruritus, a correlation first noted by physicians as early as the second century B.C.E. (Bassari and Koea, 2015).

What cancers cause itching skin? ›

The types of cancers that were most commonly associated with itching included:
  • blood-related cancers, such as leukemia and lymphoma.
  • bile duct cancer.
  • gallbladder cancer.
  • liver cancer.
  • skin cancer.

Can cirrhosis cause itchy skin? ›

Cholestasis due to hepatitis, cirrhosis, or obstructive jaundice causes itching.

What is the most common skin symptom associated with liver disease? ›

The commonest symptom in patients with liver disease is pruritus which is often protracted and disabling. Other common features include spider angiomas, palmar erythema, paper money skin, xanthelasmas, pigmentary changes, and nutritional deficiencies.

What is extreme itchiness a symptom of? ›

Common causes of itching

parasitic infestations – such as scabies. insect bites and stings. fungal infections – such as athlete's foot or vaginal thrush. hormonal changes during pregnancy or the menopause.

What medical conditions make you itch? ›

What causes itching?
  • Allergic reactions to food, insect bites, pollen, and medicines.
  • Skin conditions such as eczema, psoriasis, and dry skin.
  • Irritating chemicals, cosmetics, and other substances.
  • Parasites such as pinworms, scabies, head and body lice.
  • Pregnancy.
  • Liver, kidney, or thyroid diseases.
20 Sept 2021

Why am I so itchy but no rash? ›

Dry skin is a common cause of itchy skin without a rash. In most cases, dry skin is mild. It can result from environmental conditions, such as low humidity and hot or cold weather. It's also sometimes caused by activities that can decrease moisture in the skin, such as bathing in hot water.

How quickly does liver damage progress? ›

Acute liver failure is loss of liver function that occurs quickly — in days or weeks — usually in a person who has no preexisting liver disease. It's most commonly caused by a hepatitis virus or drugs, such as acetaminophen. Acute liver failure is less common than chronic liver failure, which develops more slowly.

What are the 3 early warning signs of liver disease? ›

If signs and symptoms of liver disease do occur, they may include: Skin and eyes that appear yellowish (jaundice) Abdominal pain and swelling. Swelling in the legs and ankles.

What can I expect in End Stage liver disease? ›

Liver failure signs and symptoms include fatigue (feeling weak or tired), jaundice (yellowing of the skin and the whites of the eyes), swelling of the legs and abdomen, appetite loss and weight loss, nausea, itchy skin and hiccups.

Can pancreas problems cause itching? ›

Also, if bile and pancreatic enzymes can't get through to the intestines to help break down fats, the stools can become greasy and might float in the toilet. Itchy skin: When bilirubin builds up in the skin, it can start to itch as well as turn yellow.

Does high bile acid cause itching? ›

There is research to show that the level of bile acids does not correlate with the intensity of itch. This means that it is possible to experience severe itching but still have low bile acid levels, and conversely have very high bile acid levels with very little itching.

What are the signs of high bilirubin? ›

What are the symptoms of high bilirubin?
  • abdominal pain or swelling.
  • chills.
  • fever.
  • chest pain.
  • weakness.
  • lightheadedness.
  • fatigue.
  • nausea.
17 Feb 2022

Can blood problems cause itchy skin? ›

Itch is common in people who have a disease that affects their blood, such as Hodgkin's lymphoma or cutaneous T-cell lymphoma. It can also be a sign of advanced kidney disease and often develops in people who are close to needing dialysis or currently receiving dialysis.

Where do you itch with lymphoma? ›

Cytokines can irritate nerve endings in the skin, which can in turn cause persistent itching. Many individuals experience this itchiness in their hands, lower legs or feet, while others feel it throughout their entire body. Patients often report that the itching tends to worsen while they are lying in bed at night.

Why is my whole body itches at night? ›

Dry skin: Your body loses moisture at night, which can make your skin itchy. Hormonal changes: At night, your body doesn't produce as many hormones as it does during the day and certain hormones reduce inflammation (swelling). As you have fewer hormones at night, your skin could be itchy.

How long can you have cirrhosis of the liver and not know it? ›

A person can remain asymptomatic for years, although 5–7% of those with the condition will develop symptoms every year. Decompensated cirrhosis: People with decompensated cirrhosis already experience symptoms and complications.

How long can you live with cirrhosis of the liver? ›

Patients with compensated cirrhosis have a median survival that may extend beyond 12 years. Patients with decompensated cirrhosis have a worse prognosis than do those with compensated cirrhosis; the average survival without transplantation is approximately two years [13,14].

What does liver failure skin look like? ›

People may have a reddish purple rash of tiny dots or larger splotches, caused by bleeding from small blood vessels in the skin. If the liver function has been impaired for a long time, people may itch all over, and small yellow bumps of fat can be deposited in the skin or eyelids.

What are two of the most common diseases that destroy the liver? ›

Most common causes
  • alcoholic liver disease—damage to the liver and its function due to alcohol abuse link.
  • nonalcoholic fatty liver disease.
  • chronic hepatitis C.
  • chronic hepatitis B.

What does your skin look like when you have liver problems? ›

Jaundice. If you have it, you may notice that your skin and the whites of your eyes look yellowish. This happens when your liver doesn't work well enough to break down a chemical called bilirubin. If too much of it builds up in your blood, your skin can turn yellow.

What are the 3 signs of a fatty liver? ›

Symptoms
  • Abdominal swelling (ascites)
  • Enlarged blood vessels just beneath the skin's surface.
  • Enlarged spleen.
  • Red palms.
  • Yellowing of the skin and eyes (jaundice)
22 Sept 2021

Why do cirrhosis patients itch? ›

Cholestasis due to hepatitis, cirrhosis, or obstructive jaundice causes itching. Although bile acids have been suggested to be a factor in pruritus9, no correlation has been found between the intensity of pruritus and bile acid concentrations in the skin or serum10,11.

What is the first stage of fatty liver? ›

The first stage is referred to as simple fatty liver or steatosis; This occurs when the liver cells start to build-up fat, although there is no inflammation or scarring at this stage. There are often no symptoms in this early stage, so many people are unaware they have a fatty liver.

What are red flags for a fatty liver? ›

Chronic fatigue or weakness. Abdominal discomfort, such as cramping or nausea. Confusion or difficulty thinking. Bruising or bleeding easily, including nosebleeds.

How do you know when your fatty liver is getting worse? ›

If you've been diagnosed with any fatty liver disease, let your health care provider know if you have any symptoms that mean the disease is getting worse. These include fatigue, loss of appetite, weight loss, weakness, fluid retention, or bleeding.

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