Can Liver Disease Cause Skin Darkening? (Hyperpigmentation)

The liver is an essential organ that rests right beneath your ribcage. 

It's roughly the size of a football, performing vital tasks related to waste filtering and metabolism (such as maintaining blood glucose levels).¹

The liver removes substances from your bloodstream, such as caffeine, alcohol, and other drugs. In addition, the liver makes proteins that help the body heal, regulate hormones, digest fat, and store nutrients.²

Poor liver function — particularly in liver disease — may be revealed by hyperpigmentation (skin darkening). 

Developing liver disease can be genetic (inherited) or caused by various risk factors such as alcohol consumption, obesity, and certain viruses, notably hepatitis. 

Liver disease and skin: what is the connection?

A healthy liver keeps your body well-regulated (metabolic homeostasis). Part of this process is delivering sufficient glucose (energy) to skin cells and hair follicles so that they can repair, regenerate, and grow. 

Individuals with poor liver function can't break down toxins effectively, which leads to their accumulation in the bloodstream and eventually other tissues and organs.

The skin is your largest organ. Often, it reveals a lot about your internal health.³ ⁴

When too many toxins accumulate in the deep layers of the skin, it causes inflammation.

Liver disease is associated with skin abnormalities in the hair follicles, nails, sweat glands, sebaceous glands, and other skin structures.⁵

Even with advanced liver dysfunction, a person will not necessarily exhibit hyperpigmentation. 

Possible signs of liver disease that are not skin-related include (but may not be limited to) dark urine and abdominal pain or swelling.

Also, skin darkening may indicate other conditions, such as type 2 diabetes (TD2).⁶

Skin darkening, also known as hyperpigmentation, may indicate that your skin produces excess melanin. Melanin is the pigment that gives skin its color. Too much melanin production (hypermelanosis) can cause small dark patches of skin, an early warning sign of liver disease.⁷

Similarly, a group of metabolic disorders known as porphyria cutanea tarda (PCT) can lead to a toxic accumulation of porphyrins (chemicals) in the liver, bloodstream, and skin, which can lead to blistering and darkening where the skin is exposed to sunlight.⁸

Skin darkening may

• Affect the entire body

• Cover large areas

• Occur in small patches

Common liver diseases and skin problems

Early manifestations of an unhealthy liver often appear on the skin in the form of the following liver problems:

Hepatitis

Hepatitis is the inflammation of the liver. Viral hepatitis A, B, C, and D reduce liver function and cause jaundice (yellowing of the eyes and skin)  since liver dysfunction promotes ​​bilirubin accumulation in the body.⁹

Cirrhosis

Too much alcohol intake can turn healthy liver tissue into scar tissue (cirrhosis) and lead to hyperpigmentation.

Fatty liver disease

Accumulation of fats in the liver can lead to either nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH). With proper diagnosis and treatment, both can damage the liver, leading to scarring and, in extreme cases, liver failure.

Drug-induced liver injury

According to hepatologists (liver specialists), about 25% of drug-induced liver injuries are accompanied by a rash. Liver injuries can be caused by herbal supplements, prescription drugs, over-the-counter medications, or illicit drugs.¹⁰

Autoimmune conditions

Autoimmune hepatitis causes your immune system to attack your liver mistakenly. If untreated, it can lead to cirrhosis and liver failure. Other autoimmune disorders leading to liver failure and cirrhosis include primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). Some individuals with autoimmune liver experience psoriasis and other skin rashes.¹¹ ¹²

Liver failure

Moderate liver failure occurs gradually. However, severe liver impairment can be sudden and require immediate medical attention. 

Skin-related warning signs of liver failure that affect the skin include

• Jaundice (yellowing of the eyes or skin)

• Bruising easily

• Itchy skin

• Edema (puffy skin)

Liver cancer

Liver cancer can occur in people that have cirrhosis, fatty liver disease, hepatitis B or C, or type 2 diabetes. Some of the symptoms include jaundice and itchy skin.¹³

Wilson's disease 

A rare genetic condition, Wilson’s disease makes the essential mineral copper accumulate in the liver, evidenced by bluish nails and yellow skin (jaundice).¹⁴ ¹⁵

How to protect your liver?

Lifestyle changes can significantly improve liver health.¹⁶

You can prevent harm to your liver by

• Limiting or avoiding alcohol consumption — talk with your doctor about whether moderate drinking or abstaining is best for your health.

• Not sharing needles if you use intravenous drugs — see if there is a syringe services program or harm reduction center in your area.

• Managing your weight by exercising and eating a nutritious diet containing lots of vegetables, fruits, whole grains, and lean protein — maintaining a healthy weight lowers your risk of developing non-alcoholic fatty liver disease (NAFLD).

• Practice safer sex – using protection reduces your risk of viral hepatitis (types B and C). Vaccines are available to inoculate against hepatitis A and B. Unfortunately, a vaccine for hepatitis C does not exist yet.¹⁷

• Limit or avoid using toxic chemicals such as bug spray, pesticides, or aerosol cleaners. If you must use these products, consider wearing a mask to reduce what you ingest — it’s your liver’s job to process and eventually eliminate these chemicals.¹⁸

• Visit your doctor for annual examinations. Liver problems may not have apparent symptoms, so ask your doctor if it’s appropriate to check your liver function based on your lifestyle and family health history.  

Skin treatment

If you're experiencing skin darkening and believe it could be liver-related, visit your doctor for advice and possible treatment. In the meantime, avoid the sun, and when you can’t, cover up or wear sunscreen to protect yourself from sun damage. 

Appropriate treatment will ultimately depend on the underlying cause of your hyperpigmentation.

Your doctor may refer you to a hepatologist, a doctor who specializes in liver health, or perhaps a dermatologist who can recommend appropriate treatment for fading or evening-out dark patches of skin.

Be very careful to work with a certified dermatologist and avoid products claiming to “cure” or lighten dark spots — the American Academy of Dermatology has warned that some products contain harmful unlisted substances, such as mercury.¹⁹

The lowdown

Your liver is a filter for everything you ingest. And while the liver is known to be resilient, many things can undermine its function, such as viruses, toxic substances, contaminants, and diseases. 

If you have liver disease and are concerned about skin darkening, consult your doctor for advice regarding suitable treatment and care. Similarly, if you’re unsure whether hyperpigmentation is related to your liver health, it’s important to get assessed by a qualified doctor as soon as possible.

Frequently asked questions

Can liver problems cause hyperpigmentation?

Yes. Some people with liver disease show hyperpigmentation and hemochromatosis (iron overload).²⁰

How does a malfunctioning liver affect the skin?

Several skin conditions, from psoriasis to acne or eczema, are connected to liver malfunctioning. An overworked and tired liver can lead to a dull complexion and itchy or dry skin.