From the Guidelines
Yes, liver disease can cause itching all over the body, a condition known as pruritus, due to the buildup of bile salts and other toxins in the bloodstream that irritate nerve endings in the skin. This widespread itching occurs because liver dysfunction leads to the accumulation of these substances, which can affect the entire body, with particular intensity on the palms and soles, and often worsens at night, significantly impacting quality of life 1.
Causes and Pathophysiology
The exact mechanisms behind liver disease-induced pruritus are complex and involve multiple pathways, including the accumulation of bile acids, alterations in the opioid system, and changes in serotonin and other neurotransmitter levels in the brain 1.
Treatment and Management
Treatment typically focuses on addressing the underlying liver condition while managing symptoms. Bezafibrate is recommended as the first-line pharmacological treatment for moderate to severe pruritus in primary sclerosing cholangitis (PSC) and other forms of fibrosing cholangiopathy, given its efficacy in alleviating moderate to severe itch in people with PSC and primary biliary cholangitis (PBC) treated with ursodeoxycholic acid (UDCA) 1.
Other options include:
- Cholestyramine (4-16g daily), which binds bile salts, though its effectiveness can vary and it may not be as potent as other treatments for some patients 1.
- Rifampicin (150-300mg twice daily), which is effective but may induce hepatotoxicity and requires regular monitoring 1.
- Opioid antagonists such as naltrexone (50mg daily), which can be effective but may have significant side effects, including opioid withdrawal-like reactions 1.
- Sertraline, an SSRI, which may have some benefit in treating pruritus, though evidence is limited, especially in the context of sclerosing cholangitis 1.
Practical Measures
In addition to pharmacological treatments, practical measures can help manage pruritus, including:
- Using mild, fragrance-free soaps
- Applying moisturizers regularly
- Avoiding hot showers
- Wearing loose cotton clothing
- Keeping fingernails short to prevent skin damage from scratching 1.
Conclusion is not allowed, so the answer continues without one.
Given the complexity of liver disease-induced pruritus and the variability in patient response to different treatments, a personalized approach to management is crucial, considering the underlying liver condition, the severity of pruritus, and the potential side effects of treatments. Regular follow-up and adjustment of the treatment plan as needed are essential to optimize outcomes and improve quality of life for patients with liver disease-induced pruritus 1.
From the Research
Liver Disease and Itching
- Liver disease can cause itching all over the body, as evidenced by studies on pruritus in patients with chronic cholestatic liver diseases, such as primary biliary cholangitis (PBC) 2, 3.
- The mechanism of itch in patients with chronic cholestatic liver diseases involves multiple factors, including bile salts, bilirubin, endogenous opioids, lysophosphatidic acid (LPA), autotaxin, and histamine, which affect itch mediators in the skin and sensory nerves 3.
- Itch is sensitized by both the peripheral and central nervous systems, and therapeutic recommendations include a guideline-based stepwise approach starting with cholestyramine, followed by rifampicin, naltrexone, and sertraline 2.
Prevalence of Itching in Liver Disease
- Pruritus is a common extrahepatic symptom in various liver disorders, particularly those with cholestatic features, with over 70% of patients with PBC affected 2.
- Chronic pruritus affects up to 56% of patients with PBC, making it a significant clinical challenge for physicians 2.
- Other liver diseases, such as primary sclerosing cholangitis (PSC) and autoimmune cholangitis, may also cause itching, although the prevalence is less well-studied 4, 5.
Treatment Options
- Treatment options for itching in liver disease include bile acid chelators, such as cholestyramine, as well as other medications like rifampicin, naltrexone, and sertraline 2, 6.
- Newer therapies, such as ileal bile acid transporter inhibitors, are being investigated and show promise for treating chronic refractory itch in patients with PBC 3, 5.
- Multidisciplinary cooperation between hepatologists, dermatologists, and pharmacists may provide better treatment for patients with liver disease and itching 3.