Causes of itching in liver disease
Pruritus is rare in alcohol-related liver diseases and nonalcoholic fatty liver diseases. It’s most commonly associated with:
- primary biliary cirrhosis (PBC)
- primary sclerosing cholangitis (PSC)
- intrahepatic cholestasis of pregnancy
Some experimental and clinical studies have been done, but scientists have yet to identify a single substance responsible for itching in liver disease. It may be that it’s caused by a combination of factors. Here are some of the possibilities researchers are looking into:
- Bile salts. If you have liver disease, you might have higher levels of bile salt accumulating under the skin, which may cause itching. Not everyone with high levels of bile salts feel itchy, and some people feel itchy despite a normal bile salt level.
- Histamine. Some people with pruritus have raised histamine levels. Antihistamines aren’t usually effective in treating it, though.
- Serotonin. Serotonin may alter itch perception. That may be why selective serotonin reuptake inhibitors (SSRIs) can help manage pruritus in some people.
- Female sex hormones. Itching sometimes gets worse during pregnancy or if you’re undergoing hormone replacement therapy.
- Serum alkaline phosphatase (ALP). People with itch related to liver disease may have elevated ALP.
- Lysophosphatidic acid (LPA) and autotaxin (an enzyme forming LPA). LPA affects many cellular functions. People with itching and liver disease may have higher levels of LPA.
How to treat itching associated with liver disease
Itching caused by liver disease probably won’t improve on its own, but it can be treated. Because the causes aren’t totally understood, it’s hard to say which treatment might work for you. It may take a combination of therapies along with a certain amount of trial and error.
It’s important to avoid scratching that itch because it can make matters much worse. Keep your fingernails short so that if you do scratch, you’re less likely to break the skin and open the door to infection. If you find yourself scratching too much, try to avoid temptation by keeping your skin covered. If you tend to scratch a lot during the night, wear gloves to bed. Here are some other things you can do to prevent skin irritation and ease itching:
- Use warm or cool water rather than hot water for showers and baths.
- Try not to spend too much time in hot environments or in the sun.
- Choose mild soaps that don’t contain added fragrances.
- Use gentle, fragrance-free moisturizers to combat dryness.
- Apply a cold, wet cloth to the itchy area until the urge to scratch eases up.
- Avoid substances or materials that irritate your skin.
- Wear gloves when using harsh products.
- Wear loose-fitting, breathable clothing.
- Use a humidifier during the dry winter months.
Apply anti-itch topicals
If you have a mild, localized itch, you can try aqueous cream with 1 percent menthol. Other over-the-counter (OTC) topicals, such as corticosteroids and calcineurin inhibitors, may also improve itching. Follow label directions and be sure to tell your doctor you’re using them. Find corticosteroid creams online.
Take prescription oral medications
Your physician may recommend oral treatments, such as:
- Cholestyramine (Prevalite). This oral medication helps remove bile salts from circulation.
- Rifampicin (Rifadin). This medication inhibits bile acids. Taken daily, it requires regular monitoring due to the potential for serious side effects such as hepatitis or renal impairment.
- Naltrexone (Vivitrol). Taken daily, this medication blocks the effects of opioids. It requires regular monitoring.
- Sertraline (Zoloft). This SSRI is also taken daily. It’s usually prescribed as an antidepressant. Other antidepressants, such as fluoxetine (Prozac), may also be used to treat chronic itch.
Try antihistamines (for sleep)
Antihistamines haven’t been shown to be effective in treating itch caused by liver disease, though they may help you fall asleep despite the itch.
Consider light therapy
Another option is light therapy, also known as phototherapy. This treatment exposes the skin to specific types of light to promote healing. It can take several sessions to start working.
Discuss a liver transplant with your doctor
When treatment doesn’t work and quality of life is severely affected, your doctor may want to discuss the possibility of a liver transplant. This may be an option even if your liver is still functioning.
Does itching indicate anything about liver disease progression or prognosis?
Liver failure is sometimes accompanied by itching. But you can develop problem itching early on, before you even know you have liver disease. In fact, pruritis can develop at any point in liver disease. This symptom alone says nothing about liver disease severity, progression, or prognosis. That doesn’t mean it’s not a serious problem. When itching persists, it can contribute to:
- impaired quality of life
Symptoms of itching with liver disease
Itching associated with liver disease tends to be worse in the late evening and during the night. Some people may itch in one area, such as a limb, the soles of their feet, or the palms of their hands, while others experience an all-over itch. Itching linked to liver disease doesn’t generally involve rash or skin lesions. However, you can develop visible irritation, redness, and infection due to excessive scratching. The problem can be exacerbated by:
- exposure to heat
- hormone replacement therapy
What other things might cause itchy skin?
Because there are so many things that cause itchy skin, it’s possible that itching isn’t related to your liver disease. A severe case of dry skin (xerosis cutis) can certainly lead to troublesome itching. Itching without rash can also be a side effect of certain medications, including opioids, statins, and blood pressure drugs. Skin conditions such as eczema and psoriasis cause itching accompanied by inflamed, red, or scaly skin. Skin itching can be due to an allergic reaction to such things as:
- poison ivy
- household cleaning products
- fabrics like wool or mohair
In addition to itching, an allergic reaction is likely to involve skin redness, rash, or hives. Other diseases and disorders that can lead to itchy skin include:
- iron deficiency anemia
- kidney failure
- multiple myeloma
- multiple sclerosis (MS) obsessive- compulsive disorder (OCD)
- pinched nerve
- shingles (herpes zoster)
- thyroid problems
Itching is also associated with:
- bacterial, viral, fungal, or parasitic skin infection
- insect bites or stings
It’s not always possible to determine the cause of itching.
When to see a doctor
If you have liver disease, see your doctor whenever you have new or worsening symptoms. That includes itching. While it may not mean anything as far as disease progression or prognosis are concerned, you won’t know that for certain without a thorough examination. It’s especially important to tell your doctor if you’re having trouble sleeping and if the itching is affecting your quality of life.
Itching associated with liver disease may be due to a variety of factors. Severe itching can lead to a host of other issues, so it’s important to see your doctor for diagnosis and treatment.