Itching: An Unknown but Not Uncommon Sign of Liver Disease

We all get a little itch now – could be dry skin, a bug bite or just a pesky itch. But continual itching all over or in one spot is another story. It can be distracting, uncomfortable and can signal a serious health concern.

An itch (technically called “pruritus”) is an unpleasant sensation of the skin that causes the urge to scratch. It can be a characteristic of many skin diseases but can also stem from an acute or chronic condition, like some types of liver disease. Itching is rare in alcohol-related liver diseases and nonalcoholic fatty liver diseases, but is most common with other types of liver diseases, including primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC), and intrahepatic cholestasis of pregnancy.

While there have been some clinical studies, scientists have yet to identify a reason for itching associated with liver disease. Experts believe it may be a combination of factors that cause it:

• Histamine- Some individuals with pruritus have higher than normal histamine levels. In recent clinical trials, antihistamines have not been found effective in treating the itching.
• Serotonin- Serotonin may alter itch perception, which may be why selective serotonin reuptake inhibitors (SSRIs) have been found to help manage pruritus in some people.
• Bile Salts- Those with liver disease may have higher levels of bile salt building up under the skin, which may cause itching.
• Female Sex Hormones- Hormone replacement therapy and pregnancy sometime cause itching to worsen.
• Serum Alkaline Phosphatase (ALP)- ALP is an enzyme found in the bloodstream that helps break down proteins in the body. People suffering from itch-related liver diseases may have elevated ALP. A simple blood draw is used to measure the amount of alkaline phosphatase enzyme in the bloodstream.

Because the causes of itching aren’t totally understood, it can be hard to treat and likely won’t improve on its own. It can be difficult to determine what will work best for everyone, but a little trial and error and a combination of therapies can have some positive outcomes.

Constant scratching can make matters worse by breaking the skin and increasing the risk of infection. Keep your fingernails short to help prevent skin damage. Here are some suggestions to help ease itching and help prevent skin irritation:

• Choose mild fragrance-free soaps.
• Use warm or cool water rather than hot for baths and showers.
• Apply a cold, wet compress to the itchy area to help fight the urge to scratch.
• Avoid the sun or hot environments when possible.
• Wear loose-fitting, breathable clothing.

Anti-itch creams with no more than 1 percent menthol can help with mild itchy areas. Corticosteroids and other over-the-counter topicals may also help improve itching. In more severe cases, your doctor may prescribe an oral medication like Zoloft, Prevalite, Rifadin or Vivitrol to help with chronic itch or to prevent or remove bile or bile acids from the bloodstream. If the urge to itch prohibits you from getting a good night’s rest, antihistamines have been known to help you fall asleep despite the itch.

Remember that itching is not always a symptom or result of liver disease. It is important to see your doctor for diagnosis and treatment and report new or worsening symptoms immediately.