What is Liver Disease Itching & How is it Treated?

A person can have itchy skin for variety of reasons. However, at times it can also be caused due to potentially serious medical conditions. One such condition is liver disease. By this, it does not mean that everyone with liver disease have itchy skin and the reason behind liver disease causing itchy skin is not very clear. The function of the liver is to break down fats, eliminate toxins, store vitamins, and produce proteins and cholesterol. It has been estimated that around 5 million people in the United States have some form of liver dysfunction. Some of the types of liver disease include disease caused due to alcohol abuse, nonalcoholic fatty liver disease, hepatitis, and primary biliary cirrhosis.^[1,2,3]

An article published in 2017 revealed that itchy skin is often associated with cholestatic liver disease like primary biliary cirrhosis. The skin is particularly severe on the soles of the feet and palms of hands. Itchy skin is seen mostly in people with primary biliary cirrhosis. Itchy skin is not that common with other types of liver diseases even though those conditions may sometimes cause it.^[1,2,3]

The main cause of Liver Disease Itching hypothetically is believed to be bile retention. However, on analyzing the data of urinary excretion of sulfated and non-sulfated bile acid in people with cholestasis and people who did not have this condition there was not much difference observed. In fact, one person did not have absolutely normal levels of bile acids but had a known diagnosis of liver abscess in skin, serum, and urine.^[1,2,3]

It was also observed that patients with primary biliary cirrhosis who had itchy skin had lower levels of bile acids than people who had mechanical biliary cirrhosis who did not have itchy skin.^[1,2,3]

As stated, the exact relationship between itchy skin and liver disease is not clearly understood. However, there are different theories that have been postulated by researchers. Some of the possible causes include:^[3]

Bile Salts: A study done in 2019 revealed that certain types of liver disease can impair the secretion of bile of which the most common is primary biliary cirrhosis. An article from 2015 makes mention of a theory that liver disease increase the levels of bile salts which gradually accumulate under the skin surface causing itchy skin. However, this is not the case in everyone who has liver disease.^[3]

Additionally, there has not been any clear link between the concentration of bile salts and the severity of skin itchiness. Another study states that liver disease causes the levels of bilirubin to rise abnormally which can also be one of the reasons for a person to have itchy skin when the peripheral itch sensory neurons become excited as a result of elevated bilirubin.^[3]

Histamine Levels: Another theory put out by researchers state that elevated levels of histamine in the body also is one of the reasons for itchy skin due to liver disease. This is seen more in people with cholestatic liver disease. However, there is no clear relation found between histamine concentration and severity of the itching.^[3]

Natural Chemicals: There are a variety of chemical processes that take place in the body meaning that there are host of naturally occurring chemicals. Some researchers suggest that these chemicals can be one of the reasons for itchy skin in liver disease. They state that the increased levels opioids in the body may be the reason behind it. In such cases opioid antagonist can be quite effective in decreasing the severity of the itchiness.^[3]

Additionally, experts state that serotonin present in the body can cause alterations in the itch perception causing increased sensation of itching in people with liver disease. SSRIs in such instances have been found to be quite beneficial in decreasing the severity of the itchy skin.^[3]

It is quite challenging to tell as to what really causes Liver Disease Itching. However there are certain steps that a person with liver disease can take to help with the itching sensation. These include^[3]

• Use of skin moisturizer to keep the skin moist^[3]
• Taking cool baths especially in hot weather so that the skin does not get dry and cracked.^[3]
• The affected area should be wrapped with a moist cloth^[3]
• Avoiding hot sun in the summer is a good way to protect the skin especially if a person has liver disease^[3]
• Wearing loose fitting clothes is also an effective way to prevent itching as tight fitting clothes rub against the skin and cause irritation.^[3]

Additionally, there are certain medications that are quite effective in getting rid of Liver Disease Itching. These include cholestyramine, Narcan, Rifadin, Zoloft, and antihistamines.^[3]

Itching is quite common in pregnant females. It most cases it is due to alterations in hormone levels or due to stretching of the skin. However, some females may get it due to a liver condition called intrahepatic cholestasis of pregnancy. This condition impairs free flow of bile acids causing them to accumulate under the skin surface causing an itching sensation.^[3]

Some of the other symptoms seen with this condition include severe itching on the sole of the feet and the palms of the hands, dark colored urine, yellowing of the eyes, and pale stools. Intrahepatic cholestasis of pregnancy usually resolves after delivery of the child. It is recommended for pregnant females wear cotton clothes, avoid sun in the hot weather, taking cool baths, and avoiding perfumes to prevent skin irritation resulting in itchy skin.^[3]

In conclusion, itchy skin at times may indicate an underlying liver problem. The mechanism behind it and the exact relationship between itching and liver dysfunction is not clearly understood but researchers have come up with certain theories that have been discussed above in great depth.^[1,2,3]

If a person has itchy skin that lasts for longer than a month should consult with a physician to get checked up for some kind of liver disease. The primary reason mentioned by researchers albeit hypothetically is the impairment of bile acid flow due to liver disease as the cause of itchy skin. If bile acid does not flow freely then it starts accumulating under the skin surface which then causes Liver Disease Itching.^[1,2,3]

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