Itching Indicates Transplant Need

Itching is associated with liver diseases and it can run the gamut from a simple annoyance to a distressing and debilitating symptom. Itching or pruritus is commonly associated with liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis, but it can be associated with all forms of liver disease.

The itching associated with liver disease has unique characteristics that differentiate it from itching caused by other conditions. Itching related to liver disease tends to be worse in the late evening and primarily affects the limbs, palms of the hands, and soles of the feet although generalized itching may occur. It is often worsened by stress, heat and contact with wool clothing. Scratching does not relieve this itching and the skin appears normal. Many people with the itching of liver disease describe their symptom as either “bugs crawling”, worsening with heat and improving with cool

The Specialist

MD

compresses. Because the mechanism of itching in liver disease is unknown, treatment is tailored to the patient. When a patient with liver disease complains of itching, the first things that should be performed are a good medical history and a skin examination to exclude any other causes of itching. If liver disease is the suspected cause, an abdominal sonogram should be performed to ensure there is no obstruction of the bile ducts which can also lead to itching. This includes such conditions as biliary tract diseases and pancreatic cancer. Medical treatments for the itching of liver disease are different than those for itching of other causes. Moisturizing creams and antihistamines are not effective and should not be used. First line agents for the treatment of mild itching from liver disease include topical creams with menthol as this will exert a beneficial cooling effect. For more severe and generalized itching, medications such as cholestyramine, rifampin, naltrexone, and sertraline can be prescribed by a health care provider. Most itching related to liver disease can be well controlled with these interventions. Rarely, the severe itching from liver disease is an indication for liver transplantation.

—David Bernstein, MD, MACG, FAASLD, AGAF, FACP