The liver is a vital conical-shaped organ responsible for several bodily functions, including detoxification and metabolism. Certain chronic conditions called liver diseases can damage the liver over time, hindering the organ’s normal functions. Those with liver disease may experience discomfort and pain, along with a unique symptom—itching. Pruritus, the medical term for itching, can interfere with daily routine. So, here is everything that can help one better understand and address itching associated with liver disease:

Liver disease
There are various types of liver diseases, each with distinct causes and characteristics. Here are the most common ones:

• Hepatitis, which is mainly caused by viruses 
• Fatty liver disease, cirrhosis, and primary biliary cholangitis (PBC)—usually a result of poor lifestyle choices
• Hemochromatosis and Wilson’s disease, which are inherited conditions
• Liver cancer and liver failure
• Primary sclerosing cholangitis (PSC)
• Intrahepatic cholestasis of pregnancy

Itching and other liver disease symptoms
Pruritus, particularly when associated with fatty liver disease, often results from impaired liver function. So, one may experience itchy skin due to liver disease, but it usually does not cause visible rashes on the skin. However, persistent scratching can result in skin irritation, heightened redness, and a higher risk of infections. Itching can be a distressing symptom of other liver diseases as well, including PBC, PSC, and intrahepatic cholestasis of pregnancy. The symptom usually worsens during the nighttime. It could be localized, affecting specific areas like limbs, feet, or palms, or a more generalized sensation of itching.

Early stages of liver diseases may not cause any symptoms, but one may notice the following signs if the condition worsens:

• Unusual tiredness and lack of energy
• Enlarged liver and blood vessels under the skin
• Swollen abdomen
• Yellow skin and eyes
• Abdominal discomfort and pain

Likely causes of itching
Itching due to liver disease is believed to be linked to several factors related to liver dysfunction. While the exact reason for the sign is not fully understood, the following factors are considered to contribute to itching associated with the condition:

Bile salt accumulation: Bile is a digestive fluid produced by the liver and stored in the gallbladder. It plays a crucial role in the digestion and absorption of fats. Liver disease can cause a disruption in the normal flow of bile, leading to the accumulation of bile salts in the bloodstream. Elevated levels of bile salts are thought to irritate nerve endings in the skin, triggering itching.

Sensitive skin cells: Itching brought on by liver disease can also be linked to increased sensitivity of skin cells, particularly keratinocytes in the outer skin layer. This heightened sensitivity triggers nerve reactions, leading to itching. The phenomenon is more prevalent in PBC, emphasizing the intricate connection between liver dysfunction and skin-related nerve responses.

Histamine release: Histamine, a compound involved in the body’s immune response, is known to cause itching. Liver diseases may cause an increase in histamine levels, triggering this symptom.

High serotonin levels: Serotonin is a neurotransmitter produced in the brain and gut. The exact mechanisms through which serotonin induces itching are not fully understood, but its role in altering itch perception and influencing the immune response is a contributing factor.

Elevated serum alkaline phosphatase (ALP): APL is an enzyme produced by the liver and other organs. Elevated levels of the enzymes may cause itching in those with liver diseases.

When dealing with liver-related issues, factors that can worsen itching include exposure to heat, heightened stress levels, menstrual cycles, and hormone replacement therapy.

Management options
There is no singular treatment option for this sign, but several strategies can be utilized to help manage it. Some of these include:

Prescription treatment: Topical creams can be useful against itching. Products with menthol have cooling properties that help soothe the skin and reduce itching.

Resist scratching: Although scratching may provide temporary relief, it can exacerbate skin irritation and potentially lead to infections. Encouraging one to adopt alternative methods for itch relief is crucial to preventing further skin damage.

Avoid hot environments: Heat can intensify the itching sensation. So, one should minimize their time in hot environments to reduce discomfort. Cooling measures, such as fans or air conditioning, can be beneficial.

Avoid irritants: One should avoid potential skin irritants like harsh soaps and lotions, especially scented ones, when dealing with itchy skin. Gentle, fragrance-free products can lower the risk of skin irritation.

Consult healthcare professionals: While home remedies and lifestyle changes can relieve itching, those experiencing persistent itching due to liver disease should consult healthcare professionals for appropriate treatments. In some cases, surgery or certain prescription options can help improve liver function. One may also be asked to manage their existing conditions like diabetes and cholesterol to allow the liver to improve naturally. Additionally, regular checkups with a healthcare professional are essential to monitor the progression of liver diseases and manage signs like itching.