“Why is my skin dry even when I moisturize and drink water?” This is a question you might ask yourself if your skin doesn’t get any less dry after you use lotion. Around 40 percent of people with primary biliary cholangitis (PBC) experience skin symptoms, with dry skin being one of the most common complaints.

Dry skin from PBC can be more challenging to deal with than dry skin from other causes, but with some supportive therapies for PBC and easy changes to your skin routine, your dry skin and itching can improve. In this article, we’ll explain why your skin gets so dry with PBC and share seven tips for managing it.

Causes of Dry Skin With PBC

You might be surprised to discover that PBC, a liver disease, is the cause of skin symptoms like dryness and itching. When your immune system destroys the bile ducts in your liver, those ducts can become blocked. This causes bile, the fluid from your liver that breaks down and helps absorb fats from your small intestine, to stop flowing as it should. The bile then builds up in your organs and bloodstream.

Dry skin, dry mouth, and dry eyes are all common symptoms of PBC. Dry skin with PBC can happen when reduced liver function triggers or worsens eczema, an inflammatory skin condition involving dryness, cracked skin, and flaking.

Many people with PBC also experience itchy skin because the excess bile salts in their blood irritate the nerves in their skin.

What Dry Skin With PBC Feels Like

Itchy skin is one of the most common PBC symptoms, and dry skin makes the itching worse. Itchy skin from PBC usually affects the hands and feet, but dryness and itching can occur in other areas or all over your body.

Beyond dryness and itching, PBC might come with other skin symptoms:

• Jaundice — Skin yellowing
• Hyperpigmentation — Skin darkening
• Xanthoma — Yellow bumps
• Fungal foot infections

How Dry Skin Affects Members

Members of myPBCteam often describe their experiences with dry skin and the severe itching that may accompany it:

• “My left hand is itching so badly that I have scratched the top layer of skin off and it bled.”
• “Just trying to make it day-to-day without scratching my skin into shreds and bleeding.”
• “I have super dry skin so I’m always using lotions and oils on my body and my feet. Not sure what else to do?”

A few members have discussed how their skin gets drier when it’s cold outside. One asked, “Do you feel like the cold months in Colorado impact your PBC symptoms?”

“I’m a little more itchy and dry. The colder weather is not tolerated as well,” responded another member.

The first member agreed, “I can totally relate to the cold weather drying up my skin and activating my eczema-prone skin.”

Managing Dry Skin With PBC

Dry skin with PBC can affect your quality of life, as it can be more challenging to deal with than itchy, dry skin from other causes. Drinking water or using lotion can help with dry skin from dehydration, but these steps don’t address the underlying processes inside your body that contribute to dry skin with PBC.

You’ll probably need to take additional steps to support both your skin and your liver. Here are a few tips:

1. Cholestyramine

Cholestyramine is a medication your doctor might prescribe if you have dry and itchy skin from PBC. It’s a type of medication called a bile acid sequestrant that reduces the amount of bile in your blood. Lowering the amount of bile in your blood might improve the skin symptoms that come from excess bile.

Cholestyramine can come in pill form or as a powder you mix into water, juice, or soup. Talk to your doctor about when and how to take cholestyramine — you might need to take vitamin supplements alongside cholestyramine because it affects your intestines’ ability to absorb certain nutrients.

2. Ursodeoxycholic Acid

Ursodeoxycholic acid or ursodiol (Urso) is a medicine commonly used to treat PBC. It promotes the flow of bile in the liver, prevents ongoing liver damage, and provides relief of symptoms, including jaundice and itching.

3. Moisturizers With Emollients

Look for moisturizers and other skin products that contain emollients. Emollients are ingredients in skin care products that create a film or barrier on your skin to reduce dryness and itching. These products have a few benefits for dry skin:

• Keep moisture from leaving your skin
• Bring more moisture to your skin
• Soften cracked and peeling skin
• Soothe dryness and irritation that’s already there

It’s important to choose a fragrance-free moisturizer, as fragrances and essential oils can irritate your skin. Alcohol and retinoids can also dry out your skin, so check product labels for these ingredients.

4. Medicated Creams

Your doctor or dermatologist might recommend or prescribe a medicated cream or ointment to treat dry skin from PBC. Creams and ointments are usually more effective at addressing dry skin than lotion and may be less irritating.

Your doctor can tell you which ingredients will be most helpful in a skin cream for PBC dry skin, such as menthol. These ingredients in ointments can also help with dryness:

• Glycerin
• Jojoba oil
• Hyaluronic acid
• Lanolin
• Shea butter
• Petrolatum
• Dimethicone

Avoid any creams or other skin products that contain sodium lauryl sulfate as this chemical can make dry skin worse.

5. Bath Time Changes

A quick bath or shower can help soothe and even hydrate dry skin. But if you have dry skin from PBC, you might need to approach bath time differently than you normally would.

Use Lukewarm Water

Even though a hot bath feels nice in the moment, hot water can make your skin drier. Use warm or lukewarm water in your bath or shower.

Limit Bath Time

Spending too much time in the bath or shower can cause your skin to lose its natural oils, leading to more dryness. Shower or bathe for just 5-10 minutes each time, and don’t do it more than once a day.

6. Moisturizing After Washing

When you apply your moisturizer matters just as much as what’s in your moisturizer. Apply your lotion, cream, or ointment immediately after washing and drying off. This will help the product trap more moisture in your skin.

7. Humidifiers

“Run a humidifier to keep moisture in the air of your house. Especially with the heat on during the winter,” recommended a member of myPBCteam.

Dry air makes skin drier, flakier, and often itchier. A humidifier in your home adds moisture to the air, which can benefit chronically dry skin from PBC.

Talk to Your Doctor

Is your skin still dry because of PBC? Talk to your doctor or a dermatologist. Your doctor might recommend treatment options to help you manage PBC symptoms including itching and dry skin. They can also provide further tips for managing dry or itchy skin at home based on your skin type and needs.

Talk With Others Who Understand

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.

Is your skin extra dry with PBC? How do you keep your skin moisturized? Share your experience in the comments below, or start a conversation by posting on your Activities page.