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You might expect to find a bruise after bumping into something or taking a fall. But for some people living with primary biliary cholangitis (PBC), bruises can appear without a clear cause.
“Does anyone else have very delicate skin that bruises and tears easily?” asked one myPBCteam member.
Another replied, “You’re not alone. I have bruising as well, along with easily tearing skin. Most times, I have no idea how I did it.”
While thin skin and easy bruising aren’t among the most recognized symptoms of PBC, some people do experience them. Read on to learn what might be contributing to these symptoms — and what you can do about them.
Several factors can increase your chances of bruising, bleeding, or developing thin skin when you’re living with PBC (previously known as primary biliary cirrhosis).
PBC is an autoimmune disease that slowly damages the bile ducts in the liver. These ducts are essential in collecting bile — a digestive fluid — from your liver cells to your intestine. Bile helps your body to digest fat-soluble vitamins, including A, D, E, and K.
When bile ducts are damaged, bile can build up in the liver instead of reaching the intestine. This can lead to vitamin deficiencies, including vitamin K, which your body needs for blood clotting and skin health.
A vitamin K deficiency can cause easy bruising and bleeding, as well as dry or thinning skin, in people with PBC. “Remember that our livers can’t absorb vitamins and minerals well, and PBC can make your skin dry and thin, as well as crack,” one myPBCteam member wrote.
To address this, your doctor may check your vitamin levels regularly. They might suggest supplements or recommend dietary changes to help restore healthy levels.
Always talk to your hepatologist (liver specialist) or another healthcare provider before starting supplements. Some supplements can interfere with your PBC treatments or worsen liver function. Your doctor can also help you choose a reputable brand — since supplements aren’t regulated by the U.S. Food and Drug Administration (FDA) the same way medications are.
Some people with PBC may experience a complication called portal hypertension. This occurs when blood pressure rises in the portal vein — the main vessel that carries blood to the liver from the intestines and spleen.
Easy bruising and bleeding can both be symptoms of portal hypertension. Other possible symptoms include:
People with portal hypertension may also have thrombocytopenia, a condition where the number of platelets — blood cells that help with clotting — is lower than normal. This is common in people with chronic liver disease and can lead to more frequent bruising and bleeding.
If you think you might have portal hypertension or thrombocytopenia, reach out to your doctor as soon as possible. They can evaluate your symptoms and help manage this complication of PBC.
As PBC progresses, it can lead to cirrhosis — a condition where too much scar tissue builds up in the liver. This scarring can interfere with liver function and may cause easy bleeding and bruising.
Other cirrhosis symptoms include:
Your liver specialist will monitor your liver health at regular visits to check for signs of cirrhosis. If cirrhosis worsens, it can increase the risk of liver cancer or liver failure. That’s why it’s so important to stay in touch with your doctor and keep up with routine care.
Pruritus (severe itching) is often one of the first — and most common — symptoms of PBC. Health experts aren’t sure exactly what causes it in people with PBC.
If you scratch your skin frequently, you may be more likely to bruise or bleed. Bruises happen when capillaries (small blood vessels) break under the skin due to pressure or injury. If the skin tears, those broken blood vessels may also cause bleeding to reach the surface.
Scratching too hard or too often can lead to bruising or bleeding, especially if you already experience these issues with PBC. In a small study of 20 people with PBC who experienced pruritus, easy bruising was one of the symptoms reported — though it wasn’t among the most common.
“When I scratch myself, I get black and blue bruises,” one myPBCteam member wrote.
Another said, “I have a friend who comes over to help me shower and get dressed again, and she puts lotion on my back because that is where I itch a lot and can’t scratch, and also on my arms where I get the black and blue bruises.”
Some medications can increase the risk of bruising or bleeding. For example, over-the-counter drugs like ibuprofen and aspirin can have this effect. So can anticoagulants (blood thinners), such as heparin and warfarin, and anti-platelet medications like prasugrel and clopidogrel.
In some cases, people with liver disease may be prescribed blood thinners to help prevent portal vein thrombosis — a blood clot that blocks blood flow to the liver.
Always talk with your hepatologist before starting any new medications, including over-the-counter drugs and herbal remedies. Even common medications can affect liver function or interact with your PBC treatments.
If you’ve ever wondered why your skin is tearing, bruising, or bleeding easily as you get older, you’re not alone. Thinning skin is a natural part of aging. As you grow older, the layer of fat under your skin becomes thinner too, which means capillaries have less protection. This can lead to more noticeable bruising.
The average age at PBC diagnosis is around 60, though it can affect people at any age. If you’re noticing increased bruising or bleeding as you age, PBC and its complications may be making these symptoms more noticeable.
To help protect thin or fragile skin, keep it well moisturized and limit sun exposure. When you’re outside, wear sunscreen, a wide-brimmed hat, and protective clothing like long sleeves and pants to help prevent sun damage.
If a bruise is painful or swollen, you can wrap an ice pack (or a bag of frozen vegetables) in a towel and hold it gently against the area for about 20 minutes.
Let your healthcare provider know if your bruising, bleeding, or skin thinning seems to be getting worse. It’s also important to continue working closely with your doctor to manage your PBC. Doing so may help you avoid further liver damage and slow disease progression. By keeping your PBC under control, you may also reduce some of the skin-related symptoms you’re experiencing.
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 PBC.
Have you noticed any skin abnormalities such as easy bruising or bleeding with PBC? How did you manage these symptoms? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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