Itchy skin (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.
In this article, we discuss the possible causes of itching in people with liver disease. We also cover how to treat it and other potential causes of itchy skin.
The liver is the body’s largest 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 people in the United States have received a diagnosis of liver disease.
Some types of liver disease include:
- alcohol-related liver disease
- nonalcoholic fatty liver disease
- primary biliary cirrhosis (PBC)
According to a 2017 article, healthcare professionals commonly associate itching with chronic liver disease, especially cholestatic liver diseases, such as PBC and primary sclerosing cholangitis (PSC). The itching typically occurs on the soles of the feet and the palms of the hands.
The authors note that the prevalence of pruritis in those with PBC is 70%.
Pruritis can also occur with PSC, but people are typically asymptomatic at the time of diagnosis. As a result, the prevalence of this symptom is unknown.
Although pruritis can affect people with other types of liver disease, it does not appear to be such a common symptom.
The understanding of the connection between itching and systemic diseases remains limited.
As medical research continues, there are different theories on the causes of liver disease itching. The proposed causes include those below.
According to a 2019 study, the secretion of bile can become impaired in a variety of liver diseases, including PBC.
A 2015 article states a theory that liver disease can increase the levels of bile salts, which then gather under the skin, resulting in pruritis.
However, not everyone who has liver disease with elevated bile salt levels experiences pruritis, and there does not appear to be an established correlation between the severity of pruritis and bile salt concentration.
Other research reports that abnormal levels of bilirubin excite peripheral itch sensory neurons. Bilirubin is a pigment of bile and leaves the body in this fluid.
There is a theory suggesting that raised levels of histamines can cause pruritis.
One study reports high levels of histamine in people with cholestatic liver disease.
However, the authors note that there is no correlation between the severity of pruritis and histamine concentration.
Naturally occurring chemicals
According to researchers, serotonin and opioids may cause pruritis in those with liver disease.
The body’s production of opioids may be higher in these individuals. Treatment with an opioid antagonist can lower levels of pruritis.
Healthcare professionals believe that serotonin can alter a person’s itch perception, resulting in increased itching. Therefore, serotonin reuptake inhibitors may also help manage pruritis.
It is difficult to determine the immediate cause of itching, but there are many self-care treatments and precautionary measures that can help.
For instance, people may be able to minimize the symptoms by:
- moisturizing the skin
- taking cool baths
- applying a cold, wet cloth to affected areas of skin
- staying out of the heat
- wearing loose-fitting clothing
- avoiding scratching where possible
Wearing a pair of gloves at nighttime can help prevent scratching while asleep.
Prescription oral medications may also help. These include:
- cholestyramine (Prevalite)
- the antibiotic rifampicin (Rifadin)
- the opiate antagonists naloxone (Narcan) and naltrexone (Vivitrol)
- a serotonin receptor antagonist called sertraline (Zoloft)
For localized and mild itches, a person can use aqueous cream with 1% menthol. This product can moisturize and cool the skin.
Although itchy skin is typically harmless and treatable, it can sometimes be a symptom of liver disease.
Warning signs that itchiness is a symptom of liver disease may include:
- very itchy skin that persists
- itching all over the body
- itching that leads to excessive scratching, causing secondary skin lesions or infection
- itching on the soles of the feet and palms of the hands, in cholestatic liver diseases
If itching is affecting a person’s quality of life, they should see a medical professional, no matter what the cause.
People who already have liver disease and experience itching should also get medical advice. However, it is not an indication of disease progression or outlook.
It is important to remember that itching is not always a direct symptom or result of liver disease. Other liver disease symptoms include fatigue, bruises or bleeding, spider veins, yellow skin or eyes, and unusual breath.
A combination of symptoms is a clearer indication of liver disease.
According to Tommy’s, a British charity, pregnant women may experience itching.
Although itching can occur during pregnancy due to stretching skin and hormones, 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.
Other symptoms of ICP include:
- itching, more noticeably on the palms of the hands and soles of the feet
- dark urine
- pale stools
ICP typically disappears after giving birth.
During pregnancy, women who experience pruritis may find the following helpful:
- wearing loose-fitting clothes
- wearing cotton clothes
- taking cool baths
- avoiding using perfumes
- avoiding spicy food, caffeine, and alcohol
There are many other possible causes of itchy skin. These include:
Pruritus can be an early symptom of liver disease.
Although the exact cause of itching alongside liver disease is unclear, there are several theories.
If a person experiences itchy skin that lasts more than 6 weeks, they should see a doctor.
This symptom can interrupt sleep, cause anxiety and depression, and lead to scarring.