Powered By
Itchy skin — also known as pruritus — is one of the most common symptoms of primary biliary cholangitis (PBC). Still, it might come as a surprise if you’re living with this liver condition. You may wonder how a disease that affects the liver could also lead to skin discomfort.
Whether you’re already experiencing itchiness or preparing for it as your PBC progresses, there are ways to find relief. This article explains what causes itching with PBC and shares four tips to help you manage this symptom. With guidance from your healthcare provider, you may be able to find a treatment that helps you feel more comfortable.
Itching is often one of the first symptoms to appear in PBC. However, since itching can be caused by many other conditions, it’s not always a clear sign of PBC. When itching is related to this autoimmune disease, it can occur anywhere on the body, but it’s most common on the arms, legs, soles of the feet, and palms of the hands. Some people describe the sensation as feeling like bugs are crawling on their skin.
A 2019 study from the United Kingdom found that 73.5 percent of people with PBC experienced itchy skin at some point. Among them, 34.5 percent reported constant itching, and 11.7 percent rated their itching as severe.
More recently, a 2022 report found that about 81 percent of people with PBC experience itchy skin. For about 30 percent, the itching was so uncomfortable that it interfered with daily life.
The effects of PBC-related itching can include:
Scientists aren’t entirely sure why PBC causes itching, but research suggests it may be related to how bile flows through the liver.
Bile ducts are small tubes that carry bile, a fluid that helps break down fats during digestion. When these ducts are damaged, as they are in PBC, bile has trouble moving out of the liver. This can cause bile acids to build up in the body and enter the bloodstream.
Once bile acids reach the skin, they may trigger nerve endings that send itching signals to the brain — even though there’s no rash or visible cause.
Everyone’s skin responds differently. For some, itching caused by PBC may be mild, while for others, it can feel unbearable. If you’re taking treatment for PBC but still experiencing intense itching, talk to your doctor. They may recommend adding a treatment that specifically targets this symptom.
Itching from PBC often gets worse at night, making it hard to sleep. Some people find relief by using over-the-counter antihistamines like diphenhydramine, but not because they stop the itch itself.
Antihistamines work by blocking histamine, a chemical involved in immune responses that can cause itching. However, they are generally not effective for treating PBC-related itching, according to recent research. That’s because histamine isn’t believed to cause this kind of itch. Still, because some antihistamines cause drowsiness, they may help you sleep through the discomfort.
The American Liver Foundation includes antihistamines in its list of symptom-relief options. If itching is interfering with your sleep, talk with your doctor. They may suggest a sedating antihistamine or another approach to help you rest, while also exploring treatments that target the itch itself.
Bile acid-binding resins are considered the first-line treatment for managing itching from PBC. Since a buildup of bile acids in the body may contribute to itching, these medications work by binding to bile acids in the gut so they can be removed from the body through stool.
The most commonly used bile acid resin is cholestyramine, which is also the only one approved by the U.S. Food and Drug Administration (FDA) specifically for itching related to PBC. It may take a few days to feel relief, and for some people, it may not work at all — but many do see improvement.
If you’re taking ursodiol (ursodeoxycholic acid or UDCA) for PBC, be aware that cholestyramine can interfere with how your body absorbs it. To avoid this, doctors usually recommend taking the medications one to four hours apart.
Possible side effects include bloating, constipation, diarrhea, and a gritty or unpleasant taste. Talk with your doctor if the side effects are bothersome. Sometimes switching the timing or the form of the medication can help.
If cholestyramine doesn’t help with itching, talk to your doctor about other medications.
Rifampin (also called rifampicin) is considered a second-line therapy for PBC-associated itching. Originally used to treat infections like tuberculosis, rifampin works differently when used for itching. It activates certain receptors in the liver that help reduce itch signals sent to the brain.
Rifampin can cause harmless but noticeable side effects, like orange or red-colored urine, sweat, or tears. In rare cases, it may cause liver problems, kidney issues, or anemia (low red blood cell counts). Because of these risks, your doctor may monitor your health closely with regular blood tests.
Opioid antagonists are medications that block opioid receptors, the parts of your nervous system that respond to opioids. Endorphins, also known as natural opioids, are chemicals your body makes to help manage pain and stress. Researchers believe these natural opioids may be involved in PBC-related itching because people with PBC often have higher levels of endorphins in their bodies. Blocking their effects with medication can sometimes help reduce the itch.
Two opioid antagonists, naloxone and naltrexone, have been studied for their role in managing itching from PBC. Naltrexone is taken as a daily pill and has been shown in small studies to reduce itching. Naloxone is available only as an injection and may also help with itch relief, although it’s used less commonly for this purpose.
These medications can be effective, but they may also cause side effects similar to opioid withdrawal, such as high blood pressure, abdominal pain, mood changes, or irritability. People living with long-term pain should be monitored closely, as opioid antagonists can sometimes worsen pain symptoms.
Selective serotonin reuptake inhibitors (SSRIs) are a type of medication commonly used to treat depression and anxiety by adjusting levels of serotonin, a chemical in the brain that affects mood, sleep, and other functions. Researchers have found that serotonin pathways in the brain may also play a role in itching for some people with PBC.
Sertraline hydrochloride, an SSRI typically prescribed for depression, has been studied for its effects on PBC-related itching. Two small clinical trials, published in the American Journal of Medicine, found that sertraline helped reduce itch in people with PBC. However, researchers noted that more studies are needed to confirm these results.
Sertraline may cause mild side effects, including dizziness, digestive issues, or insomnia (trouble sleeping).
Because itching can seriously affect quality of life for people with PBC, researchers are exploring new treatment options. One promising class of medications is called ileal bile acid transporter (IBAT) inhibitors. These drugs work by blocking bile acids from being reabsorbed in the intestines. This lowers the overall level of bile acids in the body, potentially reducing itch.
Linerixibat is an IBAT inhibitor currently being studied for PBC-related itching. In clinical trials, people taking linerixibat reported less itching and improved sleep. As of October 2025, it is not yet approved, but the FDA is reviewing the drug, and a decision is expected in 2026.
Another IBAT inhibitor, volixibat, is also in development. It has received a breakthrough therapy designation from the FDA, which may help speed up the approval process if early research continues to show benefit for PBC-related itch.
If your current treatments aren’t helping, ask your doctor whether you might be eligible for a clinical trial. These studies offer access to cutting-edge treatments and help advance future care for people with PBC.
While there’s no cure for PBC, a rare autoimmune liver disease, managing the condition can help slow its progression and may reduce symptoms like itching.
UDCA is a common first treatment for PBC. It helps move bile more effectively through the liver and into the small intestine, supporting liver function and reducing scarring. However, UDCA does not always improve itching. Fibrates are a class of medications that can be taken with UDCA, with promising outcomes for people with itching.
Another drug — obeticholic acid (Ocaliva) — was approved by the FDA in 2016 for people who did not respond well to UDCA. In September 2025, however, the manufacturer withdrew the drug, following a request from the FDA. The agency had raised safety concerns about the drug and questions about its long-term effectiveness. Severe itching is a common side effect of this medication, so it likely would worsen rather than help itching from PBC.
Fibrates are medications approved to lower cholesterol and triglyceride (fat) levels. Researchers are still unsure how fibrates work for PBC. It’s thought that they reduce the amount of bile acid in liver cells or help prevent inflammation in the liver. Fibrates have helped reduce liver inflammation and itching in people with PBC.
Elafibranor (Iqirvo) is a fibrate that was approved by the FDA in June 2024. In clinical trials, elafibranor significantly reduced itching severity for many people. In people who had previously reported experiencing six or more hours of itching per day, 58 percent of people taking elafibranor reported less than six hours of itching per day.
Seladelpar (Livdelzi) is another fibrate recently approved for PBC. In clinical trials, more people with moderate to severe itching saw significant improvement in their symptoms.
More information is needed about whether these treatments will be effective long-term. Talk to your doctor to see if adding fibrates to your treatment plan is right for you.
On myPBCteam, people share their experiences with primary biliary cholangitis, get advice, and find support from others who understand.
How would you rate your itching caused by PBC? How do you manage this symptom? Let others know in the comments below.
Get updates directly to your inbox.
Can The Gallbladder Be Removed If You Have PBC
Continue with Facebook
Sign up with your email
Become a member to get even more
Join
A myPBCteam Member
I am itching like crazy 🤪
We'd love to hear from you! Please share your name and email to post and read comments.
You'll also get the latest articles directly to your inbox.