Pruritus can develop at any stage of cholestaticCholestatic liver diseases (CLDs) are a group of diseases characterized by jaundice and cholestasis as the main presentation with different complications, which have considerable impact on the liver and can lead to end-stage liver disease, cirrhosis, and liver-related complications.https://www.ncbi.nlm.nih.gov › pmc › articles › PMC8411950
Symptoms of itching with liver disease
Itching associated with liver disease tends to be worse in the late evening and during the night. Some people may itch in one area, such as a limb, the soles of their feet, or the palms of their hands, while others experience an all-over itch.
Experts do not know precisely why itching occurs with liver disease, although several theories exist. It is not a sign that liver disease is getting worse. If a person has itching lasting more than 6 weeks , they should speak with a doctor.
Persistent Vomiting
Nausea and upset stomach are common early symptoms of liver disease, but as your liver's ability to eliminate toxins decreases, your digestive distress will likely increase. Ongoing nausea is a reaction to excess waste products in the body, and unexplained vomiting is often linked to liver problems.
See your doctor or a skin disease specialist (dermatologist) if the itching: Lasts more than two weeks and doesn't improve with self-care measures. Is severe and distracts you from your daily routines or prevents you from sleeping. Comes on suddenly and can't be easily explained.
Common causes of itching
parasitic infestations – such as scabies. insect bites and stings. fungal infections – such as athlete's foot or vaginal thrush. hormonal changes during pregnancy or the menopause.
Allergic reactions to food, insect bites, pollen, and medicines. Skin conditions such as eczema, psoriasis, and dry skin. Irritating chemicals, cosmetics, and other substances. Parasites such as pinworms, scabies, head and body lice.
Bile Salts- Those with liver disease may have higher levels of bile salt building up under the skin, which may cause itching.
If cirrhosis gets worse, some of the symptoms and complications include: yellowing of the skin and whites of the eyes (jaundice) vomiting blood. itchy skin.
For more severe and generalised itch associated with cholestasis, the American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) recommend step-wise treatment using colestyramine (cholestyramine), rifampicin (rifampin), naltrexone and sertraline.
People may have a reddish purple rash of tiny dots or larger splotches, caused by bleeding from small blood vessels in the skin. If the liver function has been impaired for a long time, people may itch all over, and small yellow bumps of fat can be deposited in the skin or eyelids.
At highly elevated levels however, such as in cutaneous jaundice (>5 mg/dL, >85.5 μM bilirubin), it is associated with pruritus, a correlation first noted by physicians as early as the second century B.C.E. (Bassari and Koea, 2015).
It takes upwards of ten years for alcohol-related liver disease to progress from fatty liver through fibrosis to cirrhosis to acute on chronic liver failure. This process is silent and symptom free and can easily be missed in primary care, usually presenting with advanced cirrhosis.
Sleep–wake disturbances are common in liver cirrhosis and associated with impaired quality of life. The most common abnormalities are insomnia (difficulties falling asleep and maintaining sleep, or unrefreshing sleep), excessive daytime sleepiness, and sleep–wake inversion (disturbances of circadian rhythmicity).
People with cirrhosis in Class A have the best prognosis, with a life expectancy of 15 to 20 years. People with cirrhosis in Class B are still healthy, with a life expectancy of 6 to 10 years. As a result, these people have plenty of time to seek sophisticated therapy alternatives such as a liver transplant.
Dry skin is a common cause of itchy skin without a rash. In most cases, dry skin is mild. It can result from environmental conditions, such as low humidity and hot or cold weather. It's also sometimes caused by activities that can decrease moisture in the skin, such as bathing in hot water.
Both vitamin B12 and vitamin A deficiencies may also cause itchy skin, so if you are experiencing chronically itchy skin, getting your level of these vitamins tested can be helpful. This testing will help determine whether these deficiencies are at the root of your skin sensitivities and itchiness.
Dry skin: Your body loses moisture at night, which can make your skin itchy. Hormonal changes: At night, your body doesn't produce as many hormones as it does during the day and certain hormones reduce inflammation (swelling). As you have fewer hormones at night, your skin could be itchy.
Itch is present in 80%-100% of patients presenting with cholestasis and jaundice[9,10] and is the primary presenting symptom in at least 25% of patients with cholestasis[11].
Signs and Symptoms
Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow. Jaundice can be harder to see in babies with darker skin color.
Chronic liver disease of any origin can cause typical skin findings. Jaundice, spider nevi, leuconychia and finger clubbing are well known features (Figures 1 a, b and Figure 2). Palmar erythema, “paper-money” skin (Figure 3), rosacea and rhinophyma are common but often overlooked by the busy practitioner.