Liver Disease And Hives: What Is The Connection?

Your liver is vital to how your body filters toxins and keeps you healthy. When you have liver problems, it can affect various other parts of your body, including your skin.

What is liver disease?

Many forms of liver disease exist. Some of the most common causes of liver disease include viral hepatitis, autoimmune diseases, cancer, nonalcoholic fatty liver disease (NAFLD, associated with obesity), inheritable conditions, and long-term alcohol abuse.¹

According to the American Liver Foundation, 4.5 million adults in the US have been diagnosed with liver disease. Additionally, millions more people with liver disease are unaware they have it.²

Liver disease is a broad term that refers to various diseases and disorders that stop the liver from carrying out its usual functions effectively.

Diagnosing and treating liver disease is critical. Untreated liver disease can lead to the formation of scar tissue throughout the liver and may progress to liver failure, which is life-threatening.

What are hives?

Hives are bumps and raised patches on the skin that are red and often itchy. The release of histamine in the skin cells, a type of immune response, causes hives. 

(Mosquito bites itch because they trigger histamine production). 

Hives are medically known as urticaria.

Hives are usually acute, meaning that they come and go relatively quickly. 

When hives last over six weeks or frequently reappear over an extended time, this is called chronic urticaria.

Hives are not contagious.

What are the symptoms of liver disease?

Viruses, genetics, and certain lifestyle factors (such as excessive consumption of alcohol) are some of the causes of liver disease. 

In general, the signs of liver disease may include:

• Fatigue

• Weakness

• Fever

• Nausea

• Loss of appetite

• Unexplained weight loss

• Pain in the upper abdomen

• Diarrhea or constipation

• Stool that is pale gray or yellow (instead of brown)

• Dark brown urine

• Itchy skin or hives

• Yellowing of the skin and whites of the eyes

• Swelling of the abdomen

• Itchy skin

• Clubbed fingers (the ends of the fingers become enlarged and rounded)

• Red and blotchy palms

• Weakness

• Confusion

• Memory problems

• Insomnia

• Personality changes

• Vomiting blood

• Black, tarry stool

• Swelling of the legs, ankles, or feet

• Frequent nosebleeds

• Bleeding gums

• Increased sensitivity to alcohol and drugs

Itchy skin is a common symptom of liver disease. However, it is usually all over the body and is not often associated with any observable changes in the skin. 

However, in some cases, people with liver disease may experience visible hives.

Can liver disease cause hives?

Yes. Hives are known to be associated with the prodromal (pre-symptomatic) stage of certain hepatitis viruses, including hepatitis A and hepatitis B.³

This means that people infected with one of these viruses may get hives before other signs of liver failure show up.

In the past, hepatitis infection was also thought to cause chronic hives. (Chronic means that a person frequently experiences hives outbreaks that last for a long time). 

However, recent research has revealed that hepatitis and chronic hives don’t seem to be linked—people with and without hepatitis have an equal chance of developing chronic hives.⁴

In addition, there are documented cases of patients having both autoimmune urticaria and autoimmune hepatitis.⁵

(In people with an autoimmune disease, the immune system activates its defenses without a threat — such as a virus or bacteria).

Autoimmune urticaria causes about 40% of cases of unexplained chronic hives.⁶

Autoimmune hepatitis is a rare cause of liver disease, although some research shows that it’s becoming more common.⁷

Although it’s known that viral hepatitis infection can cause hives, there are far more common causes of hives than liver disease. If you have hives, this doesn’t automatically mean you have something wrong with your liver. 

Liver disease is more likely to cause itchy skin without a rash. It can be severe and even debilitating for some people. Itchy skin is prevalent in people with many causes of liver failure, including autoimmune liver diseases and viral hepatitis.⁸

Common causes of hives

Many causes of hives are more common than disordered liver function. For instance:

• Contact with a particular allergenic substance, such as certain foods, bug bites/stings, latex, medications, pet dander, or certain plants (such as poison ivy)

• Sensitivity to heat or cold

• Sensitivity to sweat

• Exposure to sunlight or UV tanning

• Stress or activities that release adrenaline (such as exercise)

• Pressure or friction on the skin from clothing

• A viral infection, such as COVID-19, strep throat, or a urinary tract infection (UTI)

• Radiation treatment (usually for cancer)

Sometimes you may not know what caused your hives. For example, you may get hives from a viral infection that doesn’t cause any other symptoms, so you may never be sure what caused your hives.

Women are twice as likely to experience hives than men, with some allergy specialists pointing to hormonal fluctuations, particularly estrogen, as an inflammatory factor.⁹ ¹⁰

People with eczema, asthma, or nasal allergies are also more likely to get hives. 

Certain other diseases, including thyroid disease, are also associated with hives.

When should you suspect liver disease?

Although liver disease can sometimes cause hives, many different potential causes are much more common than liver disease. 

First, consider whether or not you have other symptoms associated with reduced liver function.

For example, if you experience jaundice (yellowing of the skin and the whites of the eyes), this is a sign that your liver is under stress. 

Elevated bilirubin (a substance created when red blood cells age and break down) causes jaundice. 

A healthy liver usually clears bilirubin from the bloodstream. But if the liver is damaged and cannot perform this function, then bilirubin builds up in the body and presents as jaundice. 

If you have jaundice along with your hives, then liver disease is a very likely cause.

There are also certain risk factors for liver disease to be aware of, such as¹¹ ¹²

• Excessive alcohol use 

• Intravenous drug use with shared needles

• Being immunocompromised

• Living with type 2 diabetes

• Having unprotected sex

• Family history of liver disease

• Clinical obesity

• Exposure to chemicals or toxins in your environment

(Some of these factors, like sharing needles or not practicing safer sex heighten the risk of contracting hepatitis, which inflames the liver).

If your hives are associated with flu-like symptoms, the cause may be an infection, which could be hepatitis. (However, another virus with flu-like symptoms could potentially cause your hives).

It’s important not to become overly anxious that hives could mean that you have liver disease. Again, most cases of hives are attributable to something other than liver disease. 

However, if you have other symptoms of liver disease, it’s imperative to talk to a medical professional.

How to treat hives

Hives are best treated by addressing the underlying cause. However, they can be highly annoying and uncomfortable until they resolve. 

To relieve the itch, try these therapeutic measures recommended by the American Academy of Dermatology Association:

• Apply a cold compress (unless cold temperatures typically worsen your hives). A cool or cold shower may also be helpful when the itching is intense.

• Over-the-counter antihistamines can help to reduce itching. If you have any medical conditions, make sure that you check with your doctor before taking any over-the-counter drugs to ensure that it’s safe for you. More potent medications are also available by prescription and may be appropriate for more severe cases.

• Avoid overheating and sweating, and don’t take hot baths or showers.

• Apply calamine lotion or a fragrance-free, hypoallergenic moisturizer to help to cool and soothe the area and reduce itching.

• Wear loose-fitting, cotton clothes so your clothes don’t irritate your skin.

• Avoid putting pressure on the affected area. For example, if you’re experiencing hives in the place where your purse or bag strap would rest, avoid carrying it there until the hives resolve.

Try to determine what triggered your hives. It may help to talk with your doctor about this, so they can help you narrow down the possible causes. 

For example, you may have a food allergy, which your doctor can identify through a skin prick test. 

Or, suppose you suspect that you are allergic to a particular fragrance or laundry soap. You could try switching to a hypoallergenic product to see if your hives will resolve. 

The lowdown

Hives can be a symptom of liver disease, but most people with hives do not have liver disease. It is far more likely that something else is causing your hives, such as an allergic reaction (most common), stress, or a viral infection.

If you have hives along with other liver disease symptoms, such as jaundice, you should speak with your doctor. 

Even if you don’t have any overt signs of reduced liver function, you may want to visit your doctor, especially if you are unsure what triggered your hives or if they have become chronic (lasting more than six weeks) or keep coming and going. If your hives are severe, then your doctor may be able to prescribe medication to help. They may also be able to help you determine the cause.

Hives do not automatically indicate liver disease, but if you are worried about your liver's health or struggling with recurring hives, get assessed by a healthcare professional.