Our skin act as a window to our overall health with internal diseases may manifest as various skin changes. Itchy skin or pruritus can be an indication of underlying medical conditions including liver problem. In fact, skin changes may be the first sign of liver disease in patients.
The hepatobiliary system is made up of the biliary system and the liver. Pruritus is the commonest and at times the most distressing symptom of hepatobiliary diseases. It can be transient and mild or persistent and severe. The reason for generalized itching with liver disease is not well understood, other than the apparent link with obstructed bile flow.
Pruritis in liver problems is believed to be due to cholestasis, an increased level of bile in the bloodstream due to blockage of its pathway. Bile is produced in the liver cells, travels out of a network of bile ducts through the pancreas and empties into your small intestine. It helps the removal of wastes by the liver and helps your intestines absorb dietary fat.
The liver neutralizes toxins and filters bile salts. If its function is impaired, accumulation of bile salts, bile acids, and bilirubin occur. Deposition of these materials in the skin is believed to cause irritation and itching. Further research is still ongoing on understanding the exact chemicals that cause the cholestatic itching, which may eventually lead to new treatment options.
Characteristic of itching in liver diseases
Widespread, or generalized itching from liver disease can appear before other signs or symptoms of cholestasis develop. Pruritus in cholestasis has a number of unique features. It is predominantly most severe on limbs, particularly on the palms and soles. It is typically worse late in the evening and at night, thus affecting sleep. It is usually exacerbated by menstrual period, hormone replacement therapy, early pregnancy, contact with wool and heat such as hot baths.3,4
It does not get relieved by scratching and usually have no visible skin lesions other than scratching signs itself. Sometimes skin lesion as a skin patch or nodule can develop on the skin and may be mistaken as primary skin problems.
Managing itchy skin due to liver problems
Itching due to liver diseases is most improved after resolving the cause of bile flow obstruction. If treating the underlying cause is not possible, several medications such as Cholestyramine and Rifampicin can help relieve the itch. Cholestyramine works by binding bile salts in your intestines so they are excreted rather than reabsorbed back into the bloodstream. Rifampicin, an antibiotic, causes an increase in liver metabolism of bile and other chemicals.
Pruritus of liver diseases is quite resistant to treatment. It adversely affects the patient’s quality of life by frequently disrupting sleep, their daily activities, and personal relationships. It can also lead to depression and even suicidal intent in extreme cases. In a rare situation, intractable itch in patients of chronic liver disease can be an indication of a liver transplant even if there is no liver failure yet.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: January 7, 2019 | Last Modified: November 29, 2019
Recognizing and treating cutaneous signs of liver disease [Internet]. [cited 2018 Dec 18]. Available from: https://www.mdedge.com/ccjm/article/95017/gastroenterology/recognizing-and-treating-cutaneous-signs-liver-disease
Koulaouzidis A, Bhat S, Moschos J. Skin manifestations of liver diseases. Ann Hepatol. 2007 Sep;6(3):181–4.
Hegade VS, Kendrick SF, Rehman J, Jones DE. Itch and liver: management in primary care. Br J Gen Pract. 2015 Jun;65(635):e418–20.
Bhalerao A, Mannu GS. Management of Pruritus in Chronic Liver Disease [Internet]. Dermatology Research and Practice. 2015 [cited 2018 Dec 19]. Available from: https://www.hindawi.com/journals/drp/2015/295891/