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Have you ever noticed a yellowish tint to your skin or eyes? Yellowing of the skin and the whites of the eyes is a telltale sign of jaundice, which itself is a sign of liver problems. So, is jaundice connected to PBC?
Primary biliary cholangitis (PBC), previously called primary biliary cirrhosis, is an autoimmune disease that causes inflammation and damage to bile ducts in the liver. PBC progression, or worsening, usually happens slowly. Many people don’t have symptoms until later in the disease. Jaundice is one symptom that tends to show up in the later stages.
Learn more about what jaundice is, why people with PBC get it, and how it can be managed. While jaundice can be alarming, it’s a useful sign that it’s time to talk to your doctor about your liver health.
Jaundice is a health condition that causes yellowing of the skin, mucus membranes (such as those inside your nose and mouth), and the white part of the eyes. The scientific term for jaundice is hyperbilirubinemia — when there is too much bilirubin in the blood. Jaundice is a later symptom of PBC and may be a sign of more severe disease.
Yellowing of the skin and eyes due to jaundice isn’t always noticeable. For example, the yellowish tint can be harder to spot on black or brown skin, but it will be noticeable in the whites of the eyes. Jaundice can also happen so gradually that you don’t notice it for a while or until other people point it out.
Other symptoms of jaundice can include:
Waiting to hear back about a potential diagnosis of autoimmune hepatitis and PBC, one myPBCteam member shared, “Itching is not bad, comes and goes, but not horrible. I am told that I look jaundiced.”
One of the liver’s many important jobs is to help the body break down and get rid of bilirubin, a component in bile. Jaundice happens when the liver is unable to remove enough bilirubin from the bloodstream or is unable to smoothly push the bilirubin through the bile channels into the space in the digestive tract. This can be a sign of liver failure. Jaundice can be caused by autoimmune conditions, like PBC, and other liver diseases. Jaundice may be a sign of a PBC flare-up.
Bilirubin is yellow in color, which is why it causes yellowing of the skin and eyes when there’s too much of it in the body.
Bilirubin gets moved through the liver via bile ducts and is eventually removed from the body. When the liver is unable to process all the bilirubin the body makes or is unable to release the bilirubin, it leads to a buildup of bilirubin in the blood. Excess bilirubin then leaks into tissues in the body, which turns the skin and the whites of the eyes yellow.
PBC is a liver disease that causes the bile ducts in the liver to become inflamed and damaged over time. Bile ducts are responsible for moving bilirubin out of the liver. Chronic inflammation of bile ducts due to PBC can cause blockages in the bile ducts, restricting the flow of bilirubin out of the liver and leading to a buildup of bilirubin in the bloodstream. Yellowing of the eyes or skin is a sign of bilirubin buildup.
Chronically inflamed bile ducts can also lead to the destruction of liver cells and fibrosis (scarring) and cirrhosis of liver tissue that worsens over time.
Skin issues are a common symptom of PBC, with about 40 percent of people with PBC experiencing skin symptoms, including jaundice, dry skin, darkening of the skin, and fungal infections. According to Mayo Clinic, PBC mostly affects women, and experts note that middle-aged women who have jaundice and pruritus (itchy skin) should be evaluated by a doctor to see if PBC is at play.
When asked what symptoms they experience with PBC, one myPBCteam member wrote, “Fatigue, joint pain, dizziness, mood changes, stomach pain, stomach swelling, and, once in a while, a yellow tint to my skin, nausea, and varicose veins.” Another member shared, “I have fatigue and yellow and dry eyes and mouth. … They have staged me at stage 3.”
There is no treatment for jaundice specifically, but it can be managed. For jaundice to go away, the underlying cause must be treated. For people with PBC, managing jaundice means helping the liver get rid of bile to prevent the buildup of bilirubin.
Ursodiol (sold as Actigall, Urso 250, and Urso Forte), also known as ursodeoxycholic acid or UDCA, helps move bile out of the liver, which can improve liver function. Ursodiol reduces toxic levels of bile acids and works for more than 50 percent of people with PBC, but up to 40 percent don’t get enough of a reduction, and 5 percent to 10 percent can’t tolerate the treatment.
For those who respond well to ursodiol and start taking it early enough, it may delay or even prevent the need for a liver transplant. People who start taking ursodiol usually take it for the rest of their lives.
Obeticholic acid (Ocaliva) is another treatment that could help manage liver problems in people with PBC and jaundice. Obeticholic acid reduces toxic levels of bile acids in the liver by increasing the flow of bile out of the liver and reducing how much bile acid is made in the liver. It also helps reduce inflammation in the liver.
Obeticholic acid may be used together with ursodiol for people with PBC who don’t have a good enough response to ursodiol or on its own for people who can’t tolerate ursodiol.
Elafibranor (Iqirvo) may help people with PBC and jaundice as it both decreases bile acid production and makes the bile acids less harmful to the liver. Like obeticholic acid, elafibranor may be prescribed together with ursodiol for people with PBC who don’t respond well to ursodiol or by itself for those whose bodies don’t tolerate ursodiol.
Since jaundice is a clear sign of liver problems, yellowing of the skin and eyes is an important signal that it’s time to talk to your doctor. You may need to add or change treatments to help your liver better manage the flow of bile and slow liver damage. Your doctor may do a blood test to see what your bilirubin levels are, which are a good indicator of prognosis with PBC.
Your doctor may also order imaging tests or a liver biopsy to better understand how your liver is doing.
Yellowing of the skin and eyes may be worrying, but it can be addressed. Talk with your doctor about ways to manage symptoms of PBC, including jaundice, to help you feel better and help your liver function the best it can.
On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with primary biliary cholangitis.
Have you had jaundice with PBC? What helped you manage it? Share your experience in the comments below, or start a conversation by posting on your Activities page.
Treatment: Primary Biliary Cholangitis (Primary Biliary Cirrhosis) — NHS
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