Itchy skin (pruritus) is one of the symptoms of chronic liver disease, although not all people with liver disease develop it. Itchy skin at night, called nocturnal pruritus, can be severe enough to interrupt sleep on a regular basis and can be as a result of natural causes or more severe health challenges like liver disease.
It could be a localized itching, such as in the lower part of your arm, or it could be a total itching. In any case, this can lead to a distracting, often overwhelming desire to scratch.
A little itching occasionally is no cause for concern. But continuous itching can interfere with sleep and cause many other problems. When this happens, it becomes a serious health problem.
In this article, we will explore the causes of itchy skin at night as it relates to liver disease, why you should consult your doctor and how to find relief.
But first, let’s look at the causes of itchy skin at night.
For most people, natural devices could be the cause of nocturnal itching. The natural circadian rhythms of your body, or daily cycles, affect the skin’s functions, such as temperature regulation, water balance, and protection.
These functions change at night. For example, both the temperature of your body and the blood flow of your skin will increase at night, heating your skin. Elevated skin temperature can cause itching.
The release of certain substances by your body also varies according to the time of day. At night, you release more cytokines, which increases inflammation. Meanwhile, the production of corticosteroids, hormones that reduce inflammation, slows down.
In addition to these factors, your skin loses more water at night. As you may have noticed during the dry winter months.
When itching occurs during the day, work and other activities distract you from the boring feeling. At night, there are fewer distractions, which can make the itching even more intense.
Health Related Causes
In addition to the natural circadian rhythms of your body, several health problems can aggravate itchy skin at night. These include:
- Renal Insufficiency
- Skin diseases such as atopic dermatitis (eczema), psoriasis and urticaria can cause itchy skin and is usually accompanied by inflamed, red, or scaly skin.
- Insects bites such as scabies, lice, bed bugs, and intestinal worms
- Kidney or liver disease
- psychological conditions such as stress, depression, and schizophrenia
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- Restless Leg Syndrome
- Iron deficiency anemia
- Thyroid problems
- Cancers such as leukemia and lymphoma
- Nervous disorders, such as multiple sclerosis, shingles, and diabetes
- Allergic reactions to substances such as chemicals, drugs, food, cosmetics, soaps, household cleaning products, fabrics like wool or mohair
The above mentioned are some general causes of itchy skin. However, below are some causes of itchy skin at night in liver disease.
Causes of Itchy Skin in Liver Diseases
Pruritus is rare in alcohol-related liver disease and non-alcoholic fatty liver disease. It is most often associated with:
- Primary biliary cirrhosis (CBP)
- Primary sclerosing cholangitis (PSC)
- Intrahepatic cholestasis of pregnancy
Some experiments and clinical studies have been carried out but scientists have not yet identified a single substance that causes itchy skin in liver disease, be it at night or not. This can be caused by a combination of factors.
Here are some of the possibilities that researchers are studying:
If you have liver disease, you may have higher levels of bile salt that build up under the skin, which can cause itching. Not everyone with high levels of bile feels itchy, and some people feel itchy despite a normal level of bile salt.
Serotonin can alter the perception of itching. This may be why selective serotonin reuptake inhibitors (SSRIs) may help control pruritus in some people.
Lysophosphatidic acid (LPA) and Autotaxin (an enzyme that forms LPA)
LPA affects many cellular functions. People with itching and liver disease may have higher levels of LPA.
Some people with pruritus have increased histamine levels. However, antihistamines are generally not effective in treating it.
Female sex hormones
The itching sometimes worsens during pregnancy or if you are going through hormone replacement therapy.
Serum Alkaline phosphatase (ALP)
Affected individuals may have a high ALP.
It is not always possible to determine the cause of itchy skin at night and since it has many causes yours might not be related to liver disease.
Therefore let us look at the general way of treating itchy skin at night before taking a look specifically on how to deal with one related to liver disease.
Treatment of Itchy Skin at Night
Here are some medications and home treatments to relieve itchy skin at night.
1. Prescription and Over-the-counter Medications
If the itching is caused by a nerve disorder or restless leg syndrome, consult your doctor. To cure the night itching, you can try an over-the-counter or prescription medication. Some of these medications only relieve the itching. Others help you sleep. Some do both.
- Older antihistamines such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril) and promethazine (Phenergan) can remove the itch and make you sleepy.
- Newer antihistamines, such as fexofenadine (Allegra) or cetirizine (Zyrtec), are also useful and can be taken at night or day.
- Steroid creams stop itching at the origin.
- Antidepressants such as mirtazapine (Remeron) and doxepin (Silenor) have an anti-itch and tranquilizer effect.
2. Alternative Treatments
To help you sleep, you can try melatonin. This natural hormone helps to regulate sleep. When you take it every night, it has a sedative effect that can help you sleep even during itching.
3. Home Remedies and Lifestyle Changes
If stress aggravates your skin, try techniques such as meditation, yoga, progressive relaxation of the muscles to calm your mind.
You can also meet a therapist in Cognitive Behavior Therapy (CBT). This program helps to reverse some of the harmful thoughts and actions that make your stress worse.
You can also try these home remedies:
- Apply an alcohol-free moisturizer such as CeraVe, Cetaphil, Vanicream or Eucerin to your skin during the day and before going to bed.
- Bath in lukewarm water and colloidal oatmeal or baking soda.
- Apply cold, damp compresses to relieve itching.
- Get a humidifier, turn it on. It will add moisture to the air in your room while you sleep.
How to Treat Itchy Skin at Night Associated With Liver Disease
Itching caused by liver disease is unlikely to improve on its own accord.
Because the causes are not completely understood, it’s hard to say what treatment might be right for you. You can take a combination of treatments with several trial and error.
1. Avoid Scratching
It is important to avoid scratching the itching, as this can make things worse. Keep the nails short to prevent the skin from breaking when you mistakenly scratch. This prevents exposure to infections.
If you discover that you can’t help but scratch, try to avoid temptation by keeping your skin well covered. If you tend to scratch a lot during the night, wear gloves at bedtime.
Here are other measures to take to prevent skin irritation and relieve itching:
- Try not to spend too much time in hot environments or under the sun.
- Avoid substances or materials that irritate your skin.
- Use lukewarm or cold water instead of hot water for showers and baths.
- Wear loose, breathable clothing.
- Use mild, fragrance-free moisturizers to combat dryness.
- Choose mild soaps that do not contain added scents.
- Wear gloves when using aggressive products.
- Apply a damp, damp cloth to the itching until the need to scratch is avoided.
- Use a humidifier during the dry winter months.
2. Try antihistamines (to sleep)
Antihistamines have not proven effective in the treatment of itchy skin, but they can help you fall asleep.
3. Apply Anti-Itch Topicals
If you have mild and localized itching, you can try a cream with 1% menthol. Other over-the-counter topicals, such as corticosteroids and calcineurin inhibitors, may also improve itching.
Follow the instructions on the label and be sure to inform your doctor.
4. Take Oral Prescription Medication
Your doctor may recommend oral treatments, such as:
- Cholestyramine (Prevalite): This oral medication helps eliminate bile salts from the circulation.
- Sertraline (Zoloft): This SSRI is also taken daily. It is usually prescribed as an antidepressant. Other antidepressants, such as fluoxetine (Prozac), can also be used to treat chronic itching.
- Rifampicin (Rifadin): This medicine inhibits bile acids. Taken daily, it requires regular monitoring because of the potential side effects of hepatitis or renal failure.
- Naltrexone (Vivitrol): Taken daily, this drug blocks the effects of opioids. Requires regular monitoring.
5. Consider Light Therapy
Another option is light therapy, also called phototherapy. This treatment exposes the skin to specific types of light to promote healing. It can take several sessions before the process of healing starts.
6. Discuss a Liver Transplant with Your Doctor.
When several treatments have been tried and it seems not to be working and the quality of life is critically affected, you might want to discuss the possibility of liver transplant with your doctor. A liver transplant can still be an option for itchy skin at night in liver disease even if your liver is still functioning.
What to do if you have itchy skin at night
If your skin itches at night, here are some triggers to avoid:
- Do not lie down with anything that bites you. Wear pajamas made of natural and soft fibers, such as cotton or silk.
- Keep the room temperature cool around 60 to 65 ° F. Overheating can cause itching.
- Avoid caffeine and alcohol before going to bed. They widen your blood vessels and send you more blood to warm your skin.
- Do not use cosmetics, scented creams, scented soaps, or other products that may irritate your skin.
- Do not scratch! You will irritate your skin even more. Keep your nails short!
Does Itching Indicate Liver Disease Progression or Prognosis?
Liver failure is sometimes accompanied by itching. However, you can develop problematic itching earlier.
In fact, pruritus can develop at any stage of liver disease. This symptom alone says nothing about the severity, progression, or prognosis of liver disease.
This does not mean that it is not a serious problem. When itching persists, it can lead to:
- Weakened quality of life
Symptoms of Itchy Skin in relation to Liver Disease
Itchy skin associated with liver disease might be worse in the late afternoon and at night. Some people may have itching on one area, such as on their limb, the soles of the feet or the palms of the hands, while others have itching all over their body.
Itching associated with liver disease generally does not include rash or skin lesions. However, visible irritation, redness, and infection may develop in case of excessive scratching.
The problem can be intensified or worsened by:
- Exposure to heat
- Hormone replacement therapy
When to See Your Doctor
Consult your primary care physician or dermatologist if:
If you have liver disease, see your doctor whenever you notice a new symptom including itching.
While this may mean nothing in terms of disease progression or prognosis, you will certainly not know it without a thorough review.
It is especially important to tell your doctor if you have trouble sleeping and the itchiness is affecting your quality of life.
As regards itching, see your doctor when;
- Itching does not improve in two weeks.
- You can not sleep because the itching is very intense
- You have other symptoms, such as weight loss, fever, weakness or rash.
Summary and Recommendation
Itchy skin associated with liver disease especially at night may be due to a variety of factors. Severe itching can lead to a number of other problems. It is therefore important to consult your doctor for diagnosis and treatment.
Use the above methods to soothe liver disease related itchy skin at night. It sure helps.
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