Liver Disease And Itching: Causes, Treatment, And Progression

You may often associate itching with a rash, allergy, or other skin condition. However, a persistent and uncomfortable itch that persists and is difficult to find relief for may be a sign of an underlying medical condition affecting the liver.

What are signs that your liver is struggling?

The liver is responsible for clearing toxins from your body and keeping your body's functions running smoothly. When you have an illness affecting your liver or your liver is damaged due to external factors, you may experience noticeable symptoms that indicate liver damage or disease. Over four million Americans have some form of liver disease, equating to nearly 2% of the population.¹

There are certain symptoms to watch out for that may signal liver problems:

• Itchiness of the skin

• Generalized pain or swelling of the abdomen

• Loss of appetite

• Nausea

• Edema or swelling of lower legs and feet

• Pale colored stool

• Yellowing of the eyes or skin

• Twitching

Causes of itching in liver disease

Although there is a correlation between itchy skin and liver disease, scientists do not know exactly why it occurs in some people with the condition but not others. While itchiness can indicate liver problems, it is not present in all cases. 

There are some potential factors that scientists believe may play a role in the itching of the skin in liver disease patients, but there is not a uniform cause that has been identified. 

Skin cells

Recent studies indicate that skin cells affected by certain lipids may be responsible for triggering the overwhelming itching sensation that some individuals with liver disease experience.²

Bile salts

Some people with liver disease may have elevated levels of bile salts in their body, leading to an itch when it accumulates in significant concentrations below the skin. However, not everyone with higher levels of bile salts experiences the itch.

Other causes

Further investigation and research over the years in trying to pinpoint the cause of itchy skin from liver disease has found other possible culprits, although they are present in some cases but not others. Possible causes include hormones, histamine, and serotonin levels.

Where do you itch with liver problems?

The area of the body that experiences the uncomfortable itching that can occur with liver disease can differ from person to person. While one patient may describe the itch as widespread, others may indicate a localized discomfort, such as in the hands, the bottom of the feet, or the legs.

The most common area reported appears to be the palms of the hands and soles of the feet. A significant itch is one that doesn’t resolve. 

What other conditions can cause itching?

Itchy skin can happen in many health conditions, including those that directly affect the skin (such as dermatological conditions) and others that are internal and related to the body's functions. With dermatology-related conditions, it is more likely you will see the area of skin affected by the condition. Systemic itching does not always cause lesions or visible irritation of the skin.

Dermatological conditions that can cause itching include:

• Psoriasis

• Eczema

• Parasites

• Dry skin

• Hives from allergic reactions

• Healing injuries or scars

• Dry skin

• Insect bite

Common systemic ailments that might also be considered the culprit when persistent itching is present include:

• Pregnancy

• Thyroid issues

• Kidney disease

• Diabetes

• Shingles

• Certain types of cancers

Symptoms of itching with liver disease

When the itching occurs periodically, it may not be a sign of liver conditions. However, if you develop an itch that persists and worsens even with home treatments, you should seek help from your doctor. Constant itchiness can be frustrating and interfere with your ability to enjoy your day-to-day life.

If you are scratching the itch, you could cause damage to your skin, and if your skin breaks open, you could become susceptible to infection.

If you have continuous itching, whether it’s widespread or concentrated in one area,  you should consider making an appointment with your doctor.

Is there any connection between itching and the stage of liver disease?

There does not appear to be any correlation between the extent of itch and the severity of liver disease. 

Studies indicate that while the extent of the itch may not reveal the severity of liver disease, it can provide some insight into the type of liver disease affecting you.³

Itching is not common in liver disease caused by fatty liver or alcohol-induced liver damage. It is more frequently reported in liver diseases that result due to autoimmune disease, obstructive biliary diseases, chronic hepatitis, and drug-induced hepatitis. 

How to treat itching from liver disease?

Finding an effective treatment for itching from liver disease can be complicated due to the various factors and unknowns that can play a part in causing the uncomfortable condition. What works for one patient may not work effectively for another. 

Work closely with your doctor to help find a solution that provides you with some relief, but be aware that this may involve some trial and error.

Oral drugs

Several oral drugs can be used to treat itching caused by liver disease. As these are prescription medications, you should speak with your doctor first to determine what is best for you. They will take into account your particular liver condition and the severity of your discomfort from itching. 

The following drugs are available:

• Colestyramine

• Colesevelam

• Rifampicin

• Naltrexone

• Sertraline

Topical creams

Over-the-counter and prescription-strength topical antihistamines have not proven effective in treating itching that originates in the liver.

Home remedies

The itching that accompanies liver disease can be distressing for some people. The constant itch can have a significant effect on your day-to-day life. While one treatment may not provide complete relief, it is possible to find certain remedies that work for you in conjunction with medication prescribed by your doctor.

What helps with itching from liver disease

• Refraining from scratching whenever you can

• Avoiding hot environments such as hot weather, hot baths, and saunas

• Using wet and cool cloths on the itchy areas for immediate relief

• Avoiding wearing tight or clingy clothing materials

While medicated topical creams may not provide relief, you can use various personal hygiene and moisturizing products to help maintain hydrated skin and avoid dryness which can exacerbate your symptoms. You can try:

• Applying a cream with a cooling effect to the affected area

• Keeping your skin hydrated by using moisturizers and drinking plenty of water

When to seek help?

Feeling an occasional itch is not cause for alarm or reason to believe you may have a liver disorder. However, if you notice that your itching is occurring more frequently or does not go away, it may be time to speak to your doctor.

Itchy skin, when temporary, is often nothing more than a minor annoyance or inconvenience. But when itching is nonstop, it can affect your sleep and emotions and alter how you approach and live each day.

If you are experiencing an itch that you cannot control with home remedies and it does not resolve in a few days, then you should discuss it with your doctor. If you believe your itching is associated with a liver condition or you are also experiencing other symptoms of liver involvement, bring it up with your doctor so they can further investigate the cause of your symptoms.

The lowdown

You should not ignore an incessant itch. While an itch could be nothing more than a bite or rash, there is a possibility that it could be a sign of damage occurring in your liver.

The sooner you get to the bottom of your itch, the sooner you can work to find a treatment that will bring you relief and address the underlying cause or medical condition. Talk to your doctor if you think you have signs of liver disease due to your itching.