Itchy skin (pruritus) – Symptoms and causes

Overview

Itchy skin is an uncomfortable, irritating sensation that makes you want to scratch. Also known as pruritus (proo-RIE-tus), itchy skin is often caused by dry skin. It’s common in older adults, as skin tends to become drier with age.

Depending on the cause of your itchiness, your skin may appear normal, red, rough or bumpy. Repeated scratching can cause raised thick areas of skin that might bleed or become infected.

Many people find relief with self-care measures such as moisturizing daily, using gentle cleansers and bathing with lukewarm water. Long-term relief requires identifying and treating the cause of itchy skin. Common treatments are medicated creams, moist dressings and oral anti-itch medicines.

Symptoms

Itchy skin can affect small areas, such as the scalp, an arm or a leg, or the whole body. Itchy skin can occur without any other noticeable changes on the skin. Or it may be associated with:

• Redness
• Scratch marks
• Bumps, spots or blisters
• Dry, cracked skin
• Leathery or scaly patches

Sometimes itchiness lasts a long time and can be intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be difficult.

When to see a doctor

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
• Affects your whole body
• Is accompanied by other signs and symptoms, such as weight loss, fever or night sweats

If the condition persists for three months despite treatment, see a dermatologist to be evaluated for skin disease. It may also be necessary to see a doctor who specializes in internal medicine (internist) to be evaluated for other diseases.

Causes

Causes of itchy skin include:

• Skin conditions. Examples include dry skin (xerosis), eczema (dermatitis), psoriasis, scabies, parasites, burns, scars, insect bites and hives.
• Internal diseases. Itching on the whole body might be a symptom of an underlying illness, such as liver disease, kidney disease, anemia, diabetes, thyroid problems, multiple myeloma or lymphoma.
• Nerve disorders. Examples include multiple sclerosis, pinched nerves and shingles (herpes zoster).
• Psychiatric conditions. Examples include anxiety, obsessive-compulsive disorder and depression.
• Irritation and allergic reactions. Wool, chemicals, soaps and other substances can irritate the skin and cause rashes and itching. Sometimes the substance, such as poison ivy or cosmetics, causes an allergic reaction. Also, reactions to certain drugs, such as narcotic pain medications (opioids) can cause itchy skin.

Sometimes the cause of the itching can’t be determined.

Complications

Itchy skin that is severe or lasts more than six weeks (chronic pruritus) can affect the quality of your life. It might interrupt your sleep or cause anxiety or depression. Prolonged itching and scratching can increase the intensity of the itch, possibly leading to skin injury, infection and scarring.

Jan. 06, 2021

Alcohol-related liver disease – Symptoms

In many cases, people with alcohol-related liver disease (ARLD) do not have any noticeable symptoms until their liver is badly damaged.

Early symptoms

If you do experience early symptoms of ARLD, these are often quite vague, such as:

Advanced symptoms

As the liver becomes more severely damaged, more obvious and serious symptoms can develop, such as:

• yellowing of the skin and whites of the eyes (jaundice)
• swelling in the legs, ankles and feet caused by a build-up of fluid (oedema)
• swelling in your abdomen caused by a build-up of fluid known as ascites
• a high temperature (fever) and shivering attacks
• very itchy skin
• hair loss
• unusually curved fingertips and nails (clubbed fingers)
• blotchy red palms
• significant weight loss
• weakness and muscle wasting
• confusion and memory problems, trouble sleeping (insomnia) and changes in your personality caused by a build-up of toxins in the brain
• passing black, tarry poo and vomiting blood as a result of internal bleeding
• a tendency to bleed and bruise more easily, such as frequent nosebleeds and bleeding gums
• increased sensitivity to alcohol and drugs because the liver cannot process them

When to seek medical advice

ARLD does not often cause symptoms until it’s reached an advanced stage. If you misuse alcohol, you may have liver damage, even though you have none of the symptoms above.

Read about alcohol misuse (drinking too much). 

Contact your GP for advice if you have a history of regular alcohol misuse.

A good way to assess your history and pattern of drinking is to use a short test known as the CAGE test, which consists of 4 questions:

• Have you ever thought you should cut down on your drinking?
• Have people annoyed you by criticising your drinking?
• Have you ever felt guilty about your drinking?
• Have you ever drunk an “eye-opener“, which means: have you ever drunk alcohol first thing in the morning to get over a hangover and steady your nerves?

If you answer “yes” to one or more of the questions above, you may have an alcohol problem and are advised to see your GP.

See your GP as soon as possible if you have symptoms of advanced ARLD.

Read more about how ARLD is diagnosed.

Page last reviewed: 10 August 2018
Next review due: 10 August 2021

Pruritus | Children’s Liver Disease Foundation

A number of medicines are available that can be used to relieve pruritus. Some people may take more than one medicine at a time and it can take some time to find the best combination.

Sometimes medicines can work well to stop the itch; however, in other cases they may work for a short time but then stop working and need to be altered. It may be difficult to find a combination that works for a particular person.

There are operations that may be considered such as biliary diversion but success is very variable.

Sometimes itching may have more than one cause, such as liver disease and eczema, so more than one treatment approach may be needed.

Some of the most common medicines used are listed here:

Ursodeoxycholic acid (Urso)

This is a type of bile acid. It works by increasing the proportion of watery bile acids in bile. This helps bile to flow more easily. It has been shown to improve bile flow in children with liver disease and can prevent further damage to their liver cells.

Some people find their itching becomes worse in the first or second week after taking the medicine. Another potential side effect is diarrhoea.

Rifampicin (Rimactane)

Rifampicin is an antibiotic. Normally a low dose is given at the start of the treatment and is gradually increased to stop the itch. It can cause urine, saliva and tears to turn an orange-red colour; this is harmless.

Cholestyramine (Questran)

This medicine combines with bile acids in the small intestine and reduces their reabsorption. The medicine can also bind with fat-soluble vitamins (vitamins A, D, E and K) and reduce their absorption. For this reason some vitamins (and some other medicines) shouldn’t be taken within two hours of taking cholestyramine.

This medicine has an unusual taste and texture. If a child is having difficulty taking it then ask your hospital team for advice.

Other medications

For severe cases of pruritus, there may be options such as ondansetron and naltrexone that can be discussed with your medical team.

New medications have been developed called apical sodium dependent bile acid transporter (ASBT) inhibitors. They stop the uptake of bile acids in the gut and therefore reduce the amount in the body and the requirement of the liver to transport them. They are not currently licensed in the UK but hopefully will be available for treatment of PFIC and Alagille Syndrome in 2022. Trials for other conditions are ongoing. They don’t work on all patients but when they do it is likely they reduce pruritus as well as liver damage.

Sedatives

A sedative is a medication which can help with sleep. This may be given if pruritus is affecting sleep.

10 Causes of Itchy Feet

The medical term for itchiness is pruritus. It can occur on the skin on any part of the body. Let’s focus on your feet. Are your feet itchy? Have you ever wondered why? Patient education is very important to us at Suffolk Foot and Ankle. We are here to treat your feet and answer all of your burning questions.

Skin changes that may accompany the itchy sensation are:

• blisters
• cracked, open areas
• dry, scale-like plaques
• itching
• rash
• redness
• swelling
• white spots

Here are the top 10 causes of itchy feet:

1. Athlete’s Foot is a contagious fungal infection that thrives in warm, moist environments. It’s commonly found in locker rooms, showers and around public swimming pools. Athlete’s Foot can be cured with an over the counter cream.
2. High blood sugar levels due to diabetes over a prolonged period of time can cause dry, itchy feet. 11% of diabetics report this as a symptom of the disease. Heavy moisturizers used daily can help in addition to monitoring blood.
3. Allergic Dermatitis can be caused by irritants such as soaps, laundry detergents or dyes in socks. It can be treated by avoiding the cause of the irritation and over the counter creams.
4. Dry skin is quite common, especially in the Winter. Long hot showers without proper moisturizing can be the culprit. It can also be inherited, not drinking enough water or a side effect from medications. Use a moisturizer on wet feet to help lock in the moisture.
5. Bugs are a seasonal problem. Pesky mosquitoes and other insects trigger the body to release the chemical histamine. This causes the area to itch. Benadryl or another topical antihistamine will remedy the itch.
6. Eczema is the blanket term for a group of medical conditions that cause itchy and inflamed skin. Flare-ups can begin in childhood and range from mild to intolerable itching. Avoiding the temptation to itch, keeping the feet free from sweat, and applying moisturizer are all important. Prescription topical or oral steroids will also reduce the symptoms.
7. Kidney or Liver Disease can lead to itchy feet. When these vital organs are not functioning properly, blood and waste remain in the body. Fluid retention causes the itching. Prescription medications or dialysis can alleviate the symptoms.
8. Pregnancy can bring on pruritus gravidarum. 20% of pregnant woman experience itching on their feet, hands, and abdomens. It is treated with corticosteroids and antihistamines. Most sufferers get relief after the baby is born.
9. Psoriasis is an autoimmune disease that causes abnormally fast-growing skin cells to accumulate and stick together in white patches. Psoriasis often affects the toes. Ointments and oral medications are used for treatment. New treatments include light therapy and injectable biologics.
10. Hypothyroidism causes a decrease in cell turnover and dry, flaky, itchy feet. Thyroid medication and over-the-counter heel balms and foot serums are used for treatment.

Schedule an appointment with us if your itchy feet don’t improve with home care or if your symptoms get worse with time!

Cholestasis of Pregnancy: Symptoms, Causes & Treatment

When you’re pregnant, it’s normal to experience a few (or a lot) of new and odd symptoms. But if you feel an extreme, intense itch on your hands and feet, be sure to see your doctor. Cholestasis — a rare but serious liver disorder — might be the cause.

Here’s what you need to know about the condition, from symptoms to treatment.

What is cholestasis?

Cholestasis is a liver disorder that most often occurs late in pregnancy, typically during the third trimester. It’s also known as intrahepatic cholestasis (ICP) or obstetric cholestasis.

Cholestasis occurs in just one to two pregnancies in 1,000. It’s more common in Latina women, occurring in about 5 percent of all pregnancies.

The condition can cause serious complications in your newborn — which is why it’s important to recognize the symptoms and talk to your doctor if you think it might be affecting you. Fortunately, early diagnosis and active management by your doctor can help ensure you and your baby have a safe and healthy pregnancy and delivery. 

What causes cholestasis in pregnancy?

A quick biology lesson: Bile, excreted by the liver and stored in the gallbladder, helps your body break down fats into fatty acids that your intestines can absorb. Cholestasis is a condition that slows down the normal flow of bile into the gallbladder, resulting in a buildup of bile acids in the liver — which in turn spills into the bloodstream, leading to intense itching.

Possible causes of cholestasis include:

• Hormonal changes: Extra estrogen during pregnancy (especially in the third trimester) can increase cholesterol levels in bile and decrease gallbladder contractions.
• Gestational diabetes: This disease is often associated with a higher risk of cholestasis.
• Genetic disposition: If an immediate family member has had cholestasis during pregnancy, be sure to tell your doctor.
• Gallstones: A collection of small stone masses in the gallbladder caused by imbalances of bile could be the culprit (pregnant women are also more at risk of gallstones due to increased estrogen levels).

Cholestasis is also more common in women carrying multiples and in those who have had previous liver damage. And if you’ve had cholestasis in a previous pregnancy, you’re also at a greater risk of having the condition in subsequent ones.

Since your chances of developing the condition can be hard to identify early in pregnancy, it’s important to check in with your doctor if you have risk factors so he or she can keep a close eye on you.

What are the symptoms of cholestasis in pregnancy?

Besides intense itching on your feet and hands, less common symptoms can include:

• Yellowing of the skin and eyes (jaundice)
• Nausea
• Vomiting
• Dark urine
• Itching in other areas of the body
• Liver enlargement and abdominal distension (an outward belly extension that’s noticeably beyond your normal baby bump)

Discomfort and itching on the palms and soles of the feet tends to be especially noticeable at night.

If the palms of your hands and soles of your feet are a bit red but not itchy, there’s no need for concern — that’s usually caused by extra estrogen and blood flow during pregnancy.

How is cholestasis diagnosed during pregnancy?

If your doctor suspects you have cholestasis, she’ll want to run a diagnostic test — usually a blood test known as a fractionated bile acid test, but sometimes a liver function test (though the results of the latter alone may not be enough to diagnose the condition).

Since the results may take 10 to 14 days to get back, it’s very important to talk to your doctor as soon as you think you may be experiencing symptoms of cholestasis.

What are the risks associated with cholestasis?

With regular prenatal care and monitoring, your baby will likely not be affected by cholestasis during pregnancy and after delivery. Studies have found little increased risk to babies when their mothers have only mild cholestasis and low amounts of bile acids.

In cases when maternal bile acids are higher, cholestasis can increase baby’s risk of a low birth weight, a slightly lower Apgar score, lung immaturity and preterm delivery — which is why early diagnosis and treatment are so important.

In extremely rare cases, stillbirth is a risk, though it can be prevented if labor is induced early. The risk of stillbirth goes up after 36 to 37 weeks, which is why getting diagnosed as soon as possible is so important.

How is cholestasis treated in pregnancy?

While it isn’t possible to prevent cholestasis during pregnancy, your doctor may prescribe treatments such as topical anti-itch medications, lotions, corticosteroids and medication to help the liver function properly and reduce its bile acid levels.

Your practitioner will closely monitor your baby’s health and development with additional tests, such as nonstress testing (NST) and a fetal biophysical profile (BPP). He or she will also likely recommend that you visit a high-risk obstetrician who practices maternal-fetal medicine, so you can deliver in a special hospital where you and your little one can be monitored and managed closely. You will most likely also have to be induced a bit early.

The good news is that all of these symptoms usually disappear on their own within 48 hours after birth. Until then — with early diagnosis and proper treatment to manage your condition — you’ll stay healthy during pregnancy and can look forward to a happy, healthy life with your baby.

For more information on cholestasis, visit ICPCare.org.

Itching sensation originates in the skin cells themselves, after signaling from an excess of lipid — ScienceDaily

A devastating itching of the skin driven by severe liver disease turns out to have a surprising cause. Its discovery points toward possible new therapies for itching, and shows that the outer layer of the skin is so much more than insulation.

The finding, which appears April 2 in Gastroenterology, indicates that the keratinocyte cells of the skin surface are acting as what lead researcher Wolfgang Liedtke, MD PhD, calls ‘pre-neurons.’

“The skin cells themselves are sensory under certain conditions, specifically the outermost layer of cells, the keratinocytes,” said Liedtke, who is a professor of neurology at Duke School of Medicine.

This study on liver disease itching, done with colleagues in Mexico, Poland, Germany and Wake Forest University, is a continuation of Liedtke’s pursuit of understanding a calcium-permeable ion channel on the cell surface called TRPV4, which he discovered 20 years ago at Rockefeller University.

The TRPV4 channel plays a crucial role in many tissues, including the sensation of pain. It was known to exist in skin cells, but nobody knew why.

“The initial ideas were that it plays a role in how the skin is layered, and in skin barrier function,” Liedtke said. “But this current research is getting us into a more exciting territory of the skin actually moonlighting as a sensory organ.” Once a chemical signal of itching is received, keratinocytes relay the signal to nerve endings in the skin that belong to itch-sensing nerve cells in the dorsal root ganglion next to the spine.

“Dr. Liedtke and I had a longstanding interest in the role of TRPV4 in the skin, based on our previous collaborations we decided to focus on chronic itch,” said Yong Chen, and assistant professor of neurology at Duke who is first author on the study.

The researchers found that in a liver disease called primary biliary cholangitis (PBC), patients are left with a surplus of lysophosphatidylcholine (LPC) a phosphorylated lipid, or fat, circulating in the blood stream. They then demonstrated that LPC, injected into the skin of mice and monkeys, evokes itch.

Next they wanted to understand how this lipid could lead to the aggressive itching sensation. “If the itch comes up in PBC, it’s so debilitating that the patients might need a new liver. That’s how bad it can get,” Liedtke said. Importantly, the skin is not chronically inflamed in PBC, meaning there is debilitating itch in the absence of chronic skin inflammation.

The researchers found that when LPC reaches the skin, the lipid can bind directly to TRPV4. Once bound, it directly activates the ion channel to open the gate for calcium ions, which are a universal switch mechanism for many cellular processes.

But in this case, the signal does something surprising. The researchers followed a signaling cascade inside the cell in which one molecule hands off to another, resulting in the formation of a tiny bubble back on the skin cell’s surface called a vesicle. Vesicles are designed to bud off cells and carry whatever is inside them away.

In this case, the bubbles contained something surprising: micro-RNA, and it functioned as a signaling molecule. “This is crazy, because microRNAs are normally known to be gene regulators.” Liedtke said.

It turns out that this particular bit of microRNA is itself the signal that evokes the itch.

Once they had identified it as microRNA miR-146a, the researchers injected the molecule by itself into mice and monkeys and found that it immediately caused itching, not hours later, as it would if it were regulating genes.

“Future research will address which specific itch sensory neurons respond to miR-146a, beyond the TRPV1-dependent signaling that we have found, also its in-depth mechanism,” Chen said.

With the help of German and Polish liver specialists who have blood collections and itch data on PBC patients, the researchers discovered that the blood levels of microRNA-146a corresponded to itch severity, as did the LPC levels.

Knowing all the parts of the signaling that leads from excess phospho-lipid, LPC, to intolerable itching gives scientists a new way to look for advanced liver disease markers, Liedtke said.

And it points to new avenues for treating the itch, either by possibly desensitizing the TRPV4 channels in skin with a topical treatment, attacking the specific microRNAs that drive the itch, or targeted depletion of LPC.

Management of Pruritus in Chronic Liver Disease

Background. There continues to be uncertainty on the ideal treatment of pruritus in chronic liver disease. The aim of this study was to gather the latest information on the evidence-based management of pruritus in chronic liver disease. Methodology. A literature search for pruritus in chronic liver disease was conducted using Pubmed and Embase database systems using the MeSH terms “pruritus,” “chronic liver disease,” “cholestatic liver disease,” and “treatment. ” Results. The current understanding of the pathophysiology of pruritus is described in addition to detailing research into contemporary treatment options of the condition. These medical treatments range from bile salts, rifampicin, and opioid receptor antagonists to antihistamines. Conclusion. The burden of pruritus in liver disease patients persists and, although it is a common symptom, it can be difficult to manage. In recent years there has been greater study into the etiology and treatment of the condition. Nonetheless, pruritus remains poorly understood and many patients continue to suffer, reiterating the need for further research to improve our understanding of the etiology and treatment for the condition.

1. Introduction

Pruritus or itch is a common symptom seen in a number of illnesses. It is an unpleasant sensation of irritation of the skin. Pruritus can further be classified as localised or generalised depending on the affected area and acute or chronic depending on the duration of the symptom. Chronic pruritus is defined as presence of pruritus for more than 6 weeks. Pruritus associated with liver disease has been well described as early as the 2nd century BC when the Greek physician Aretaeus the Cappadocian observed an association between pruritus and jaundice [1]. Pruritus is a common clinical feature seen in most liver diseases but particularly frequently in cholestatic liver disease. Cholestatic liver disease can be further classified into intra- and extrahepatic disease. Chronic pruritus is more frequently seen in intrahepatic cholestatic diseases such as primary biliary cirrhosis (PBC), intrahepatic cholestasis of pregnancy, chronic hepatitis B and C, familial intrahepatic cholestasis, and Alagille syndrome. However, pruritus is also seen in extrahepatic cholestatic liver diseases such as primary sclerosing cholangitis (PSC) and cancer of the head of pancreas [2].

Pruritus contributes a large symptomatic burden to those suffering from liver diseases. A recent survey reported that pruritus occurs in 69% of PBC sufferers and, for 75% of these patients, pruritus was present before the diagnosis of PBC, possibly suggesting pruritus as a diagnostic criterion. Pruritus in PBC can be very debilitating as approximately 65% of PBC sufferers report itching to occur especially at night time, thus affecting sleep. In some PBC patients, pruritus is worse after meals and premenstrually [3]. Cholestasis, pruritus, and jaundice are the main clinical features of progressive familial intrahepatic cholestasis [4]. Furthermore, 15–31% of hepatitis C sufferers complain of chronic pruritus. In all of these cases, pruritus in chronic liver disease tends to be generalised, chronic, intermittent, and of varying severity. It adversely affects patient’s quality of life by frequently disrupting sleep [5], their daily activities, and personal relationships. It can also lead to depression and even suicidal intent in extreme cases [6]. Due to the subjective nature of pruritus there is an added difficulty in determining its severity and in treating it. Due to incompletely understood etiology and various different treatments available for pruritus, there remains ambiguity regarding the ideal approach to the treatment of this condition. In light of this, this review aimed to collate all published literature on the pathophysiology and management of pruritus in chronic liver disease in order to address this issue.

2. Methodology

A literature search for pruritus in chronic liver disease was conducted using Pubmed and Embase database systems using the MeSH terms “pruritus,” “chronic liver disease,” “cholestatic liver disease,” and “treatment.” This is summarised in supplementary figure  1 in Supplementary Material available online at http://dx.doi.org/10.1155/2015/295891.

2.1. Eligibility Criteria

All prospective and retrospective studies that recruited patients of any age and identified pruritus through clinical assessment were selected. Relevant studies needed to have a longitudinal follow-up of at least 24 hours duration and to report on pathophysiology, treatment, or outcomes. Papers were restricted to patients with chronic liver disease alone.

2.2. Information Sources and Search Strategy

In January 2014 a systematic search utilising PubMed/Medline and OVID search engines was conducted. The initial search was undertaken using MESH search for “pruritus” and “liver disease” and key phrases as listed in supplementary Figure  1. To capture the most recent literature in the field and to ensure that our analysis was based on contemporary datasets, the time period of literature search was limited to the past 20 years (January 1994–January 2014). The results of papers focusing on management were limited to papers focusing on human subjects and in the English language.

2.3. Study Selection

The abstracts were screened and relevant articles meeting the above criteria were selected. Searches were conducted by the authors who independently checked titles and abstracts against the eligibility criteria and subsequently obtained full-text versions of all potentially relevant papers, which were then further considered for final inclusion.

3. Results

3.1. Pathophysiology

The exact pathogenesis of pruritus in chronic liver disease is unknown; however, several hypotheses have been suggested. Pruritus induced by certain substances known as pruritogens is one of the implicated theories. Several pruritogens have been identified over the years. The “bile salts theory” proposes bile salts as the pruritogen. Cholestatic liver disease increases levels of bile salt which accumulate under the skin causing itch. This theory is further supported by studies showing that ingestion of bile salts in cholestatic patients worsens pruritus [6, 7] and intradermal injection of bile salts causes pruritus in healthy persons [8, 9]. Additionally, when bile is removed through nasobiliary drainage or partial external biliary diversion in a cholestatic patient, pruritus is significantly reduced [10, 11]. However, there still exists no established correlation between the bile salt concentration and severity of pruritus [12, 13]. Furthermore, not all cholestatic patients with elevated levels of bile salts experience pruritus [14] and, additionally, pruritus also occurs in patients with normal levels of bile salts [12].

Histamine is also one of the strong contenders as a pruritogen in cholestatic pruritus. Raised histamine levels are found in cholestatic pruritus sufferers [15]; however, again there is no correlation between histamine concentrations and severity of pruritus [16] and antihistamines are often ineffective in treating pruritus in this setting [17]. Opioids, serotonin, and female sex hormones have all been implicated in the etiology of pruritus. Increased levels of endogenous opioids are reported in chronic liver disease [18, 19] and treatment with an opioid antagonist is shown to reduce pruritus [20–22]. Serotonin is believed to induce pruritus by altering itch perception [17] and so serotonin reuptake inhibitors such as sertraline have reported to be effective in managing pruritus [23].

Female hormonal influence on cholestatic pruritus is seen in different liver diseases. The intrahepatic cholestatic pruritus of pregnancy is self-limiting and often resolves after pregnancy. In addition, symptoms in preexisting primary biliary cirrhosis and primary sclerosing cholangitis female sufferers can sometimes worsen during pregnancy when there are raised female sex hormones [7]. Generally, increased itch sensation is apparent during pregnancy and in women taking hormone replacement therapy [8].

Recent research on cholestatic pruritus have identified another pruritogen called lysophosphatidic acid (LPA). Lysophosphatidic acid is a phospholipid which affects a range of cellular functions. Autotaxin (ATX) is an enzyme which cleaves lysophospholipase to form LPA. Both LPA and autotaxin levels are raised in patients with cholestatic pruritus. Additionally, studies on mice reveal that intradermal injections of LPA produce a dose-dependent induction of pruritus [16, 24]. Pregnane X receptor (PXR) which is a nuclear steroid receptor is believed to have a vital role in ATX synthesis; however, the mechanism still remains unclear. In vitro studies have shown that the PXR agonist rifampicin reduces ATX synthesis and hence reduces pruritus [9].

In terms of the transduction of pruritus sensation, there are two main theories. The first is the intensity theory which proposes that the same neuronal pathways carry both the itch and pain stimuli. As a result, a weaker stimulus gives an itch perception and an increased stimulus gives the perception of pain. The second is the specificity theory, which suggests that a different group of nerves carries the itch and pain perception separately and factors such as genetics, diet, and environment may be responsible for varying susceptibility for pruritus between individuals.

3.2. Management of Pruritus

There has been a plethora of work investigating possible treatment options for pruritus in the setting of chronic liver disease. These medical treatments range from bile salts, rifampicin, andopioid receptor antagonists to antihistamines. Additionally nonpharmacological management such as skin moisturisers, avoidance of skin irritants, and avoiding hot environments can also prove to be very beneficial in reducing pruritus.

Bile salt resins such as cholestyramine are usually the first line treatment for pruritus in cholestatic disease. Several studies have shown the efficacy of bile salt resins in symptom control of pruritus [10, 11]. Cholestyramine is an effective medication with minimal side effects, which include gastrointestinal upset, unpleasant taste, and rarely fat malabsorption. Ursodeoxycholic acid (UDCA) is one of the bile acids which has been shown to improve jaundice, improve ascites, and improve liver function in primary biliary cirrhosis [12], however, has little benefit on pruritus [13]. It is, however, highly effective in intrahepatic cholestasis of pregnancy (ICP) [14] and hence UDCA is currently only indicated in the treatment of ICP in light of a recent randomised control trial which showed that UDCA improves pruritus and is safe to use during pregnancy [18]. More recent research has explored farnesoid X nuclear receptors in maintaining homeostasis in bile acid synthesis and farsenoid X receptor agonists may prove to be an upcoming treatment option for PBC [19].

Rifampicin is another effective treatment option for cholestatic pruritus, especially in pruritus refractory to therapy and in malignant cholestasis [20, 21]. A recent meta-analysis of randomized controlled trials highlighted the safety of rifampicin in the treatment of cholestatic pruritus [22]. However, regular blood test monitoring is still needed for patients on rifampicin treatment owing to the risk of hepatotoxicity [16]. μ-Opioid receptor antagonists such as naloxone or naltrexone are also shown to be effective in the management of cholestatic pruritus [15, 24, 25]. However, opiate withdrawal reaction is one of the common side effects and hence this treatment option should be avoided in patients with drug addiction issues [25]. It should also be avoided in patients with acute hepatitis and liver failure. Finally, in a placebo-controlled trial, selective serotonin reuptake inhibitor sertraline was shown to be more effective than placebo group in controlling pruritus [23].

Contrary to established doctrine, a recent review has shown that topical antihistamines are not very effective in the treatment of pruritus [26]. There are still new emerging therapeutic options for pruritus treatment for patients who remain refractory to the abovementioned treatments. Although further evidence is needed to further test their efficacy. Albumin dialysis using molecular adsorbent recirculating system is one of them. A multicentric analysis concluded that the dialysis was significantly effective in pruritus management [27]. Similarly plasmapheresis is suggested as a treatment option for primary biliary cirrhosis in pregnant woman [28].

There are several other potentially useful agents in the management of chronic liver disease-associated pruritus but to date have only been confined to isolated case reports and small-scale series and so cannot be recommended. However, these are discussed here for completeness and include thalidomide, ondansetron, phenobarbital, and stanozolol. Thalidomide is an example of a primary antipruritic agent which has shown promise in primary biliary sclerosis. Its side effects can include significant drowsiness, suggesting a central depressant mechanism underlying it action [1, 2]. Ondansetron is a serotonin 5-HT3 receptor subtype antagonist that is effective in the management of nausea and vomiting. Although it is usually tolerated well with few side effects, there is only anecdotal evidence to support its use in pruritis from chronic liver disease and studies have provided mixed results [3–5]. Similarly, phenobarbital or phenobarbitone is a long-acting barbiturate and has also been investigated in reducing pruritus in chronic liver disease; however, it also does not appear to have a clear beneficial effect [6, 17]. Stanozolol is a synthetic anabolic steroid derived from dihydrotestosterone. Although it relieves pruritus, it also worsens cholestasis and so cannot be recommended [23].

4. Discussion

The impact of pruritus on the quality of life of patients suffering from chronic liver failure is often underestimated by physicians. Although the severity of pruritus is variable between patients, it can have significant implications on a patient’s mental health and psychological well-being. The paucity of clinical literature addressing pruritus in liver patients demonstrates the lack of focused research on the topic and in turn highlights the difficulty faced by the physician when confronted with treatment-resistant patients with pruritus.

The underlying pathophysiology is unclear and is likely to be a result of a number of interrelated complex pathways with multifactorial etiologies [29]. The European Association for the Study of the Liver (EASL) has established guidelines for the initial clinical assessment, investigation, and management of pruritus in cholestatic liver diseases [30]. The approach to management should be in a step-wise fashion starting with the simple agents listed above and then escalating to more experimental treatments in resistant cases. An appropriate approach would be to start with UDCA and then cholestyramine followed by rifampicin and naltrexone and if symptoms persist this may be followed by therapies such as sertraline [31]. Experimental therapies such as UVA/B light therapy or other experimental drug therapies can be reserved for cases resistant to conventional therapy [32].

Hence it is clear that, due to poorly understood pathophysiology, there is no one single ideal treatment for all chronic liver disease patients suffering from pruritus. Although there are several treatment options available, achieving optimum symptom control may require a trial and error process to find the best regime for each patient. Nonetheless, despite available treatments a small number of sufferers may not respond to any therapy and this group may require liver transplant, even in the absence of liver failure, to treat their symptoms [30, 33, 34].

This review was restricted to published literature in the English language and confined to the eligibility criteria described in the methods section. Due to the heterogeneity of the outcomes measured in the literature and the wide remit of this review a quantitative analysis was not feasible. Nonetheless the general conclusions from the current evidence base have been presented. The future of experimental research in this field will focus on novel agents in the treatment of pruritus; however, basic research into understanding the underlying etiology and signaling of pruritus is paramount for pharmacological progress in this field. Nonetheless there is also a clear need for focused work in phase III and IV studies comparing the clinical effectiveness of established agents and combinations thereof in different etiologies of liver disease and different patient subgroups in order to strengthen the evidence base upon which clinical guidelines can be set.

5. Conclusion

The burden of pruritus in liver disease patients persists and although it is a common symptom, it can be difficult to manage. Despite there being a large body of research into the etiology and treatment of the condition, pruritus remains poorly understood and many patients continue to suffer. What is known has been presented in this review but the field requires continued basic science research to help broaden our knowledge of the etiology of pruritus and more clinical research on treatment options to help improve the quality of life of chronic liver disease patients.

Ethical Approval

Ethical approval was not required for this work.

Conflict of Interests

The authors have no conflict of interests.

Authors’ Contribution

Angeline Bhalerao and Gurdeep S. Mannu contributed equally.

Supplementary Materials

Supplementary Figure 1: In January 2014 a systematic search for pruritus in chronic liver disease was conducted using PubMed/Medline and Embase database systems using the MeSH terms “pruritus,” “chronic liver disease,” “cholestatic liver disease,” and “treatment.” The process of paper selection is illustrated in this figure. All prospective and retrospective studies that recruited patients of any age and that identified pruritus through clinical assessment were selected. Relevant studies needed to have a longitudinal follow-up of at least 24 hours duration and to report on pathophysiology, treatment, or outcomes. Papers were restricted to patients with chronic liver disease alone. To capture the most recent literature in the field and to ensure that our analysis was based on contemporary datasets, the time period of literature search was limited to the past 20 years (January 1994–January 2014). The results of papers focusing on management were limited to papers focusing on human subjects and in the Eng-lish language.

1. Supplementary Material

90,000 Yellow eyes: disease or nothing to worry about? Do I need to take action?

Have you noticed that the whites of your eyes have turned yellow? Jaundice, overuse of certain medications, or other medical conditions, sometimes even serious ones, can cause yellowing of the eyes.

This article explains everything there is to know about yellowing eyes and what to do with it.

What causes yellowing of the eyes?

The sclera (white of the eye) should always look white .If suddenly it turns red or changes its color, it is necessary to contact an ophthalmologist to identify the cause of the color change.

Icterus (yellowness) of the conjunctiva

One of the reasons for the change in eye color can be icterus of the conjunctiva. This is the medical term used for yellowing of the eyes. (Sometimes the term “icterus sclera” is also used to describe yellowing of the eyes).

Jaundice

In most cases, yellow eyes are a symptom of jaundice: due to an increase in the level of bilirubin pigment, the skin and eyes change their color.Although jaundice itself is not a disease, it indicates that the liver, gallbladder, and bile ducts are not functioning properly.

Jaundice is most common in newborns. According to the US Centers for Disease Control and Prevention (CDC), approximately 60% of all newborns are prone to jaundice. Premature babies are at increased risk because their livers have not yet developed enough to clear bilirubin.

Jaundice is much less common in older children or adults.If this happens, then, as a rule, the presence of a more serious illness that requires treatment is suspected. As in the case of newborns, the first thing to pay attention to is the liver.

Mild cases of neonatal jaundice usually resolve on their own. Only 1 in 20 children may need specialized treatment. The standard treatment for mild jaundice is light (phototherapy), which lowers bilirubin levels, and the child usually recovers very quickly.

Note. The change in eye color with jaundice does not affect vision.

Diseases associated with yellowing of the eyes

The most common diseases that can cause yellowing of the eyes:

• Acute pancreatitis, or pancreatic infection

• Certain types of malignant tumors, including cancer of the liver, pancreas or gallbladder …

• Hemolytic anemia (congenital blood disease), characterized by a lack of red blood cells as a result of their premature decay.

• Malaria (an infectious blood disease) transmitted by mosquito bites.

• Certain blood disorders that affect the production and life cycle of red blood cells, such as sickle cell disease.

• Rare genetic diseases that affect the liver’s ability to excrete bilirubin.

Other diseases and drugs that can cause yellowing of the eyes:

• Autoimmune diseases that affect the human immune system.Hepatitis A, B, and C viruses infect liver cells, causing acute (fleeting) or chronic (long-term) hepatitis and yellowing of the eyes.

• Obstructive jaundice can occur when one or more of the ducts that drain bile from the liver into the gallbladder are blocked by stones in the gallbladder. As a result of a violation of the outflow, bile is absorbed into the blood.

• Cirrhosis, the end stage of chronic liver disease when scarring occurs, reduces the liver’s ability to filter bilirubin.Cirrhosis occurs as a result of various forms of liver disease, including hepatitis, non-alcoholic steatohepatitis, and chronic alcoholism. All of these diseases cause yellowing of the eyes.

• Certain medications, such as over-the-counter acetaminophen (if consumed in excess) or prescription drugs such as penicillin, oral contraceptives, chlorpromazine, and anabolic steroids, can also cause yellowing of the eyes.

Pinguecula: Not quite yellow eyes, but…

Another disease that causes yellowing of the eyes is pinguecula.

Pinguecula is a yellow deposit that appears on the surface of the sclera, causing this part of the eye to turn yellow.

The eye does not turn yellow completely, but only in the place where the pinguecula grew.

Such formations can be caused by excessive exposure to UV rays during prolonged exposure to the sun. If the pinguecula grows larger and causes discomfort, surgery is indicated.

OTHER MATERIALS ON THIS TOPIC: Pinguecula (yellow formation on the eye): definition, causes and methods of removal

Treatment of yellow eyes

Treatment of yellow eyes depends on the underlying cause of yellowing of the eyes.

Yellowing of the eyes is a visible sign of certain medical conditions. At the same time, it is important to determine the accompanying symptoms in order to find out the nature of the health problem.

The following accompanying symptoms may occur: itching of the skin, bloating, fatigue, fever, light stools, dark urine, loss of appetite, nausea, and sudden weight loss.

In order to prescribe the correct and effective treatment, it is necessary to conduct an examination, including checking the level of bilirubin in the blood, making a detailed clinical blood test and checking the liver.

The results of the examination, analysis of symptoms, history, physical examination of the patient and possibly studies using diagnostic imaging methods will help to make a correct diagnosis.

If an infectious disease, such as hepatitis C or malaria, is the root cause of yellowing of the eyes, antibiotics, as well as antifungal and antiviral drugs may be prescribed.

If the patient has a history of excessive use of alcohol or drugs, treatment should begin with the cessation of the use of these substances.

Diet can also play a significant role. The liver processes and metabolizes most of the nutrients that enter the body. But difficult-to-digest substances make it difficult for her to work. These are refined sugar, salt and fat, which are high in saturated fatty acids.

Patients with jaundice are advised to follow the drinking regimen and eat foods that are good for the liver – fruits and vegetables, whole grains, healthy proteins, nuts and legumes.

As the liver recovers after a course of treatment, jaundice and yellowing of the eyes also disappear.

In some cases, surgery may be necessary to correct concomitant factors, such as blockage of the bile ducts.

Yellowing of the eyes? Visit an ophthalmologist

If you think your eyes are yellow, see an ophthalmologist immediately.

After a thorough eye examination and if an illness is suspected, an optometrist or ophthalmologist may refer you to a specialist or other doctor.

Do not underestimate yellowing of the eyes. If liver disease or other disease is the underlying cause, prompt diagnosis and effective treatment can prevent a serious complication that can result in internal organ damage.

Page published in November 2020

Page updated June 2021

Interventions in case of paracetamol (acetaminophen) overdose

Review question: In this review, we reviewed the evidence for the interventions (treatments) used for paracetamol (acetaminophen) poisoning in humans.Basically, we tried to assess the impact of these interventions on the number of deaths and the need for liver transplantation.

Relevance: Paracetamol is one of the most common drugs taken in excess of the prescribed dose. Intentional or accidental paracetamol poisoning is a common cause of liver damage.

Date Searched: Evidence is current to January 2017.

Study characteristics: randomized clinical trials (studies in which people are randomly assigned to one of two or more treatment groups) in which participants sought medical attention because they took an overdose of paracetamol, deliberately or accidentally, regardless the amount of paracetamol taken, the age, sex, or other medical conditions of the patient.

There are many different interventions that can be used to treat people with paracetamol poisoning. These interventions are aimed at reducing the absorption [absorption] of paracetamol in the digestive tract and, therefore, reducing the amount of paracetamol that enters the bloodstream. These drugs include activated charcoal (which binds paracetamol in the stomach), gastric lavage (to remove as much paracetamol as possible from the stomach), or ipecacuana (a syrup that causes vomiting (nausea) when taken orally).After absorption, paracetamol enters the liver through the bloodstream, where most of it breaks down into safe components. However, a small portion of this drug turns into a toxic product that the liver can usually handle, but taking large amounts of paracetamol is too much for the liver. As a consequence, the toxic product can damage the liver and lead to liver failure, kidney failure and, in some cases, death. Other interventions to treat paracetamol poisoning include drugs (antidotes) that can reduce toxic products (such as the drug cimetidine) or break down toxic products (include drugs such as methionine, cysteamine, dimercaprol, or acetylcysteine). Finally, attempts can be made to remove paracetamol and its toxic products from the bloodstream using special blood purification equipment. All of these treatments have been studied.

We found 11 randomized clinical trials involving 700 people. Most of these trials looked at different treatments.

Key results: Activated charcoal, gastric lavage, and ipecac may decrease absorption of paracetamol when used within one to two hours of paracetamol intake, but clinical benefit is unclear.Activated charcoal is arguably the best choice if a person can take it. Sometimes people cannot ingest activated charcoal due to drowsiness or because they do not like the taste, structure (or both of these factors).

Of the treatments aimed at removing toxic paracetamol products, acetylcysteine ​​is likely to reduce the incidence of liver damage from paracetamol poisoning. In addition, it has fewer side effects than other antidotes such as dimercaprol and cysteamine; its advantage over methionine was unclear. Acetylcysteine ​​should be prescribed to people with paracetamol poisoning at risk of liver damage, the risk depends on the dose taken, meal time and laboratory data.

The most recent clinical trials looked at ways to reduce the incidence of side effects using intravenous (through a vein) administration of acetylcysteine, changing the route of administration. These clinical trials have shown that using a slower infusion and a lower starting dose of acetylcysteine ​​can reduce the incidence of side effects such as nausea, vomiting, and allergies (unwanted reactions from the body to a drug, such as a rash).

Quality of Evidence: This review of interventions for paracetamol poisoning found a surprisingly small number of published randomized clinical trials for this fairly common condition. In addition, most trials had few participants and all trials had a high risk of bias. Accordingly, the quality of the evidence should be considered low or very low.

How to cleanse the liver – cleaning and restoring the liver at home

The liver is one of the most important organs of our body

The liver performs a variety of functions that are necessary for the normal functioning of the body and maintaining health: protective, metabolic, secretory and detoxifying.

Liver detoxification function

One of the main functions of the liver is to detoxify toxins.
The liver works as a filter: it traps toxic substances,
formed in the body itself or supplied with food, through the lungs and skin ¹ .

Toxins are harmful substances from food and the environment that can accumulate in the body. The most well-known toxins that we encounter every day are airborne substances, alcohol and preservatives ² .However, not only exogenous, that is, coming from outside, substances need to be neutralized. A variety of biochemical processes take place in the body, the products of which are also toxins and can harm our body ³ .

Liver damage caused by toxins

The liver is an organ with a great potential for self-healing, but malfunctions can occur in its work. An excess of toxins negatively affects the functioning of liver cells – hepatocytes.Too much fat accumulates in the liver cells due to the fact that the cells do not have time to process them. In addition, there is an excess formation of free radicals and inflammation develops. This leads to damage to the cell membrane. Damaged liver cells cannot function normally and need help. The cells will die if not helped at this stage.

After the death of liver cells, neighboring cells take over their function. But gradually they also cease to cope with the increased load, they die, and scars form in their place.Normal liver tissue becomes connective tissue that cannot perform the normal functions of the liver ⁴ .

Repetitive or permanent liver damage, such as with regular alcohol consumption, can cause severe scarring. Initially, the body is able to adapt to the fact that the healthy liver tissue is partially replaced by scars, but eventually, the scars can become so large that the liver can no longer perform its normal functions ⁴ .

The appearance of heaviness or pain in the right hypochondrium, impaired appetite, bitter taste in the mouth, increased fatigue, swelling of the legs, itching, spontaneous bruising and bleeding gums indicate that the liver cannot remove toxins and its cells need to be restored ⁵ . ..

Healthy products for the liver

Keeping a healthy lifestyle and avoiding alcohol are important steps towards restoring liver structure and function ⁶ .

Foods that restore liver cells are vegetables, herbs, fruits, berries, fish, lean meat, low-fat dairy products, legumes, nuts and vegetable oils such as olive oil. Including these foods in your daily diet can have a positive effect on liver function ⁷ .

Healthy eating rules for the liver

⁸

• Avoid foods high in fat, sugar and salt. Avoid fried foods and fast food.
• Minimize or eliminate alcohol consumption.
• Try to balance your diet. The daily diet should contain fruits, vegetables, cereals, meat, fish or legumes, milk and vegetable oils.
• Include fiber-rich foods in your diet. Dietary fiber helps support the functioning of many organs, most notably the liver and intestines.

Major international studies show that we need 30 grams of fiber per day ⁹ . Dietary fiber is found in whole grains (10-15 grams in 100 g of oats, buckwheat or quinoa), vegetables (2 grams in 100 g of carrots, 2 grams in 100 g of cauliflower), fruits (2-4 grams in 100 g of sweet fruits , in 100 grams of berries – 5-8 g) and legumes (9-13 grams per 100 g of product).

• Drink plenty of water. Our body needs about 30 ml of liquid per 1 kg of body weight, that is, a person weighing 70 kg needs to drink 2 liters a day.
• Avoid carbonated drinks.A healthy alternative is plain water or tea.

According to a large Japanese study, drinking green tea improves liver, heart and vascular performance by lowering fat levels ¹⁰ . Black tea is also beneficial: it protects liver cells from damage caused by foods high in fat ¹¹ .

Preparations for the restoration of liver cells

Hepatoprotectors are the helper drugs that allow you to eliminate the causes of damage to liver cells and restore the cells themselves. Hepatoprotectors increase the liver’s resistance to the effects of toxins and normalize the function of its cells ¹² .

1. Plant hepatoprotectors

These are products based on milk thistle extract, licorice root and artichoke leaves.

Research results indicate that the use of milk thistle preparations can promote bile stasis ¹³ . And licorice-based products can lead to water retention in the body and an increase in blood pressure, which limits their use ¹⁴ .

2. Animal hepatoprotectors

The basis of these drugs for the restoration of liver cells is a hydrolyzate of the liver of pigs or cattle. Unfortunately, there are no clinical studies proving their effectiveness ¹⁵ . Also, against the background of these drugs, an allergy ¹⁵ may develop.

3. Preparations with essential phospholipids

The basis of the hepatoprotective agent is soybeans or soy lecithin.

Preparations with essential phospholipids restore liver cell membranes. However, liver damage is not limited only to membranes and requires more comprehensive repair ¹⁶ .

In addition, phospholipids can be obtained from ordinary food: eggs, cod, chicken breast, peanuts and many other products contain a comparable amount of phospholipids with drugs ^17.22 .

4. Cholagogue

Recently, for the “cleansing” of the liver, drugs have become popular that increase the formation of bile and improve its excretion from the body.Bile is produced in the liver (about 1.5 liters per day), stored in the gallbladder and then excreted into the duodenum, where it is involved in digestion.

Unnecessary substances processed by the liver can be excreted with bile. However, drugs that increase the formation and excretion of bile are best treated with caution. Increased flow of bile can lead to biliary colic and displacement of stones. The use of choleretic drugs is strictly contraindicated in cholelithiasis ¹⁸ .

5. Products with amino acids

These liver cell regeneration products contain essential amino acids and their derivatives, such as ademetionine (Heptral ^® ).

Toxins have a detrimental effect on the liver. In response, the formation of the vital amino acid ademetionine ¹⁹ is reduced in the liver. With liver diseases, the organ cannot provide itself with a sufficient amount of ademetionine and needs outside help. It is impossible to get ademetionine from food, the drug Heptral ^{® 20} helps to replenish its level.

Heptral ^® triggers detoxification reactions inside the liver. In this case, the natural regeneration of cells comes from the inside. Heptral ^® reduces inflammation in the liver, repairs damaged liver cell membranes and improves bile excretion ²⁰ .

Heptral ^® helps to eliminate toxins, restore liver function and improve well-being after the 1st week of administration. And the effect of taking Heptral ^® can persist for 3 months after the end of treatment ^20.21 .

“Cleansing” the liver consists primarily in the restoration of cells, because only healthy cells can properly remove toxins.

90,000 What causes vaginal discomfort?

01/22/2021

What causes vaginal discomfort?

Many women periodically experience discomfort in the genital area.They are subjective and can have various manifestations. Discomfort means itching, burning, unusual discharge from the genital tract, rashes, and an unpleasant odor.

Some gynecological diseases can provoke such discomfort:

• vaginal candidiasis (thrush)

• bacterial infections (vaginitis, vulvovaginitis, colpitis)

• STIs (herpes, chlamydia, ureaplasmosis, mycoplasmosis, trichomoniasis, condylomas)

• changes associated with menopause (kraurosis of the vulva, atrophy of the vaginal membrane, etc. )etc.)

However, discomfort can be caused by diseases not related to the reproductive system.

For example, with diabetes mellitus, intestinal dysbiosis, cystitis, diseases of the kidneys, liver, thyroid gland, allergies, infection with helminths and protozoa, etc.

Unpleasant sensations in the intimate area may be associated with physiological factors. These are physical and emotional stress, hypothermia / overheating, taking certain medications, weak immunity, pregnancy, poor nutrition.As well as non-observance of the rules of personal hygiene, individual intolerance to the composition of intimate hygiene products, allergy to latex and intimate lubrication, wearing low-quality underwear.

In most cases, conservative treatment methods are sufficient to eliminate the problem. To do this, it is enough to regularly visit a gynecologist and not postpone a visit to him at the first unpleasant symptoms.

But do not forget about the most elementary preventive measures:

• Eat right

• Lead an active lifestyle

• Choose Your Personal Care Products Carefully

• Avoid hypothermia and overheating

• Wear natural fabrics

• Avoid unprotected sex

Caring for the health of patients, obstetrician-gynecologist Larisa Anatolyevna Saracheeva.

Make an appointment for a consultation at the Reaviz multidisciplinary clinic by phone: 321-21-21.

90,000 Liver disease, symptoms and signs of liver disease from a doctor – Healthy lifestyle and health

Liver malfunctions are often disguised as other ailments

What are the symptoms and signs of liver disease and how to diagnose liver disease in yourself, the Segodnya.Lifestyle website was told by an experienced doctor Anatoly Pechenka, who had previously named the most harmful alcoholic drink for the liver.The doctor is sure that the external manifestations of liver problems can be insignificant and mimic diseases of other organs – from the nervous system to sexual dysfunction, and the digestive organs almost always suffer, masking liver problems.

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“Be attentive to the state of your body if you periodically worry about heaviness in the right hypochondrium, skin rashes reminiscent of allergies, weight loss and unusually rapid fatigue, decreased potency (in men) or menstrual irregularities (in women ), as well as nosebleeds – do not postpone the visit to the doctor, the expert advises. “And it should be not only a doctor of a specific specialty, but also a specialist who can deal with possible liver pathology.”

Liver diseases: symptoms and signs

1. Severity in the right side;
2. Flatulence;
3. Abdominal discomfort;
4. Pain after eating fatty foods;
5. Bitterness in the mouth in the morning.Sweetish or fishy odor in the morning should also alert;
6. Darkening of urine, gray feces, the appearance of yellowness of the skin;
7. Any rashes, spots, acne, lichen , moles, fungus, spider veins, which manifested themselves in adulthood, should alert.For example, a rash is often attributed to allergies. In fact, it can be a symptom of liver disease, which is unable to effectively remove toxins from the body, which is manifested by skin rashes. In this case, it is better to play it safe and consult only with a dermatologist, but also with an infectious disease specialist or gastroenterologist.

What signals “speak” of a sick liver

“Once a middle-aged woman who suffered from frequent allergic rashes that appeared for no apparent reason came to me for a consultation,” says Anatoly Pechenka, doctor of the Regeneration liver treatment clinic . ..- I was treated by an allergist, dermatologist, but the effect of the prescriptions was short-term and after 3-4 weeks the rash returned. During the examination, it became clear that the patient had a so-called immune-independent allergy: the rash manifested itself when a special fraction accumulated in the bile, causing allergic rashes when it was absorbed into the blood. The patient underwent duodenal intubation, while a large amount of bile was stimulated, which was removed through a tube from the intestine. The condition immediately improved, the rash did not appear for 4-5 months.Later, she was already in the family outpatient clinic, once every six months, was probed with the removal of bile. “

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In addition, the doctor is sure that liver disease may not manifest itself for a very long time. a girl with adverse reactions to a drug prescribed by a gynecologist, continues the doctor Anatoly Pechenka. – She was in serious condition and all turned yellow. In the hospital, she was diagnosed with liver cirrhosis. It turned out that initially the patient turned to the gynecologist with complaints of menstrual irregularities and excessive hair growth on the legs.But among the adverse reactions to the hormonal drug was a toxic liver reaction. Already in intensive care, it was found that irregularities in the cycle and hair growth in the legs were associated with severe liver dysfunction due to cirrhosis. “

Liver cirrhosis: the main symptoms

• Small spider veins on the skin also signal hepatitis and even cirrhosis. Permanent blush of the cheeks in combination with bronze pigmentation of the skin and itching may also indicate hereditary hemochromatosis of the liver and the development of cirrhosis.
• Red palms indicate chronic liver damage: possible hepatitis or cirrhosis.
• General pruritus and scratching often accompany cirrhosis or intrahepatic bile stasis.
• Weight loss . Significant weight loss for no apparent reason is an alarming indicator. As a rule, in the initial stages of liver disease, weight loss is rather the exception, but for cirrhosis of the liver, this is, alas, the norm. In turn, obesity and weight gain also signal that the liver is overloaded with cholesterol and fat.
• Depression and depression . Changes in the emotional state are characteristic of hepatitis, high cholesterol and liver hepatosis. A person complains of a breakdown, causeless depression. If this condition does not go away even after two weeks of rest, this is a sign of a serious malfunction in the body.

“Make it a rule to annually take a biochemical blood test, which includes” liver “enzymes (ALT, AST) and total bilirubin, do ultrasound of the liver and other abdominal organs at least once a year, even better – elastometry”, – advises doctor.

Today, 11:45

Today, 08:15

Today, 10:40

As a reminder, the doctor named the main superfruits for the treatment of the liver. In addition, the most useful fruit for the liver has been found. We also wrote that in no case should people with a diseased liver do it.

Watch the video: formula for success: the diet of successful people

Read also:

Vladimir Grisyuk
Editor

Lifestyle writer with 9 years of experience.Writes about entertainment, contemporary culture and travel. He graduated with honors from the magistracy of the Institute of Journalism of the KNU, as well as the Faculty of Law of the VNU. Postgraduate student, PhD candidate in the field of mass communications. Member of the National Union of Journalists of Ukraine (NSJU). Collaborated with the following publications: Gazeta po-Ukrainski, Gazeta.ua, Novoye Vremya, Media Detector. Conducts an author’s column in the magazine “Kraina”.

More articles from this author

90,000 Pruritus in the elderly, senile pruritus, symptoms and types of pruritus

Pruritus in the elderly is quite common. This symptom causes a lot of inconvenience and constant discomfort for the elderly person, as well as his environment. In old age, itching of the skin of the body is a persistent unpleasant sensation that makes you scratch the affected parts of the body intensively, and most often it is a natural signal of malfunctions in the body.

Types of pruritus in the elderly.

Skin itching is divided into acute, chronic, localized. The causes of this symptom can be very different. In therapeutic practice, there is a pathogenetic classification:

1. Itching accompanying various skin diseases.
2. Itching as a manifestation of paroneoplasia.
3. Idiopathic pruritus.

Anyone who has ever experienced itching of the skin of the body knows how uncomfortable it is. Identifying the cause of pruritus is often a difficult task, which sometimes requires a comprehensive medical approach and a thorough medical examination. Consider in general terms senile itching (senile), which is common in old age, which affects half of people after 70 years.

Senile pruritus.

Senile pruritus is a common manifestation in old age. With age, the skin becomes dry. The epidermis no longer produces enough elastin, which affects the condition of the skin. Overheating of the body from the desire to dress warmer, dry air in the room, frequent water procedures – all this increases the likelihood of problems. It is important to distinguish senile itching from the reaction of the skin to other problems that have accumulated in the body with age – chronic diseases of internal organs, neurotic disorders, allergic reactions, skin diseases and infections, fungal skin lesions.

Main differences between senile pruritus from other diseases:

• The intensity of itching varies, up to very painful;
• has no complications in the form of purulent inflammation;
• Itching intensifies in the evening;
• itching can bother for months, then stop, then resume; 90 042 90 039 atypical places for combing;
• Continuous scratching polished nails.

Diagnosis of pruritus that bothers in old age is the competence of a general practitioner and gerontologist.To diagnose senile itching, it is necessary to exclude pathological causes of itching :

Allergies and hepatitis C

23 nov. 2019 09:00

Hepatitis C virus is an infection that affects the liver. Chronic cases lead to liver failure if left untreated. The organ itself is responsible for a number of functions, including digestion.

Allergic skin manifestations may be a symptom of HCV. It has been linked to liver damage and even side effects of HCV treatment.

Early symptoms

Hepatitis C is characterized by inflammation (edema) of the liver. Because it is involved in many important functions.

When an organ is damaged, it will not work properly. Hepatitis C sometimes causes many symptoms, the most notable of which are:

• jaundice;

90,039 abdominal pain;

• dark urine and light stool;
• fever;
• excessive fatigue.

As the illness persists and progresses, other signs may be noticed, including an allergy in the form of a rash.

Acute phase and urticaria

Acute HCV usually lasts six months or less.

During infection, the person may develop a red itchy rash as the body tries to rid itself of the virus.

Urticaria is the most common in the acute course of the disease. It manifests as itchy redness on the skin and sometimes leads to swelling and often goes away within a few hours.

Allergy indicates severe liver damage

HCV can become chronic.

In such cases, serious organ damage occurs.

These signs appear on the skin.

Skin symptoms include:

• redness;
• severe itching;
• development of spider veins;

90,039 brown spots;

90,039 dry skin spots.

Other concomitant manifestations include stomach edema and bleeding that does not stop.

Therapy

Some skin rashes are caused by HCV.

Treatment causes an allergic reaction.

This is common when medications are injected.

In such cases, a rash may develop at the injection site.

Cold compresses and hydrocortisone cream relieve the itching and discomfort of a rash.

If rashes appear that are not at the injection site, this is a sign of a rare reaction to the mixture.

Therefore, it is necessary to consult a doctor.

In order to get rid of allergies, you must first destroy the phages.

This is possible with the use of effective direct-acting antiviral drugs, with effective medicines included in them:

• Sofosbuvir;
• Daclatasvir;
• Ledipasvir;
• Velpatasvir.

You can find out about the possibilities of these mixtures on the Hepatitis-Stop website.

The instruction of Sofosbuvir, as one of the components of therapy, can also be read on the indicated website.

Rash detection

A rash can be difficult to diagnose because of multiple causes.

In addition to injection sites, HCV allergies are common in the chest, arms and trunk.

Acute HCV sometimes causes temporary facial eruptions, including swelling of the lips.

Treatment and prevention

In acute hepatitis C, the best way to fight is to take antihistamines and topical ointments to relieve itching.

Chronic HCV rash is more difficult to treat due to the ongoing nature of the disease.

If it is caused by a certain course, the doctor will most likely change the scheme.

You can reduce the intensity of the rash, for this you need:

• to limit the stay at the sun;
• take warm or cool baths;
• Use a moisturizing, unscented soap;
• Apply skin lotion immediately after bathing.

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