Fatty liver disease and eczema are both common conditions in the UK, affecting millions of people. Whilst fatty liver disease involves excess fat accumulation in the liver, eczema is a chronic inflammatory skin condition causing dry, itchy patches. Many people wonder whether these conditions are connected—specifically, whether fatty liver disease can cause or trigger eczema. Understanding the relationship between liver health and skin conditions is important for anyone managing both. This article examines the current medical evidence, explores potential indirect links, and provides practical guidance on managing both conditions safely and effectively.
Summary: Fatty liver disease does not directly cause eczema according to current medical evidence and UK clinical guidance.
- Fatty liver disease is a metabolic condition affecting the liver, whilst eczema is an immune-mediated inflammatory skin disorder with distinct causes.
- No established causal link exists between fatty liver disease and eczema; neither NICE nor British Association of Dermatologists guidance recognises fatty liver as an eczema trigger.
- Both conditions may share certain risk factors such as systemic inflammation and metabolic syndrome, but correlation does not imply causation.
- Systemic eczema treatments including methotrexate, azathioprine, ciclosporin, and JAK inhibitors require regular liver function monitoring.
- Lifestyle modifications beneficial for fatty liver disease—including Mediterranean diet, weight management, and regular exercise—may support overall health and reduce systemic inflammation.
- Seek urgent medical attention for jaundice, confusion, vomiting blood, or severe abdominal pain, which may indicate serious liver disease complications.
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Understanding Fatty Liver Disease and Eczema
Fatty liver disease, medically termed hepatic steatosis, occurs when excess fat accumulates in liver cells. The two main types are non-alcoholic fatty liver disease (NAFLD), which affects people who drink little or no alcohol, and alcoholic fatty liver disease (AFLD), caused by excessive alcohol consumption. NAFLD is increasingly common in the UK, affecting approximately one in three adults, often associated with obesity, type 2 diabetes, and metabolic syndrome. NAFLD encompasses a spectrum of liver conditions, ranging from simple steatosis (fat accumulation alone) through non-alcoholic steatohepatitis (NASH, with inflammation and liver cell damage) to progressive fibrosis, cirrhosis, and an increased risk of hepatocellular carcinoma. The condition typically develops silently, with many people unaware they have it until detected through routine blood tests or imaging. It is important to note that liver blood tests (such as ALT and AST) may be normal in NAFLD, so normal results do not exclude the condition.
Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterised by dry, itchy, and inflamed patches of skin. It affects around one in five children and one in ten adults in the UK. The condition results from a combination of genetic factors, immune system dysfunction, and environmental triggers. Common symptoms include red, scaly patches, intense itching, and skin that may weep or become thickened with repeated scratching. Eczema often appears on the hands, inside elbows, behind knees, and on the face and scalp.
Whilst both conditions are relatively common in the UK population, they arise from fundamentally different mechanisms—one primarily metabolic and hepatic, the other immunological and dermatological. Understanding each condition independently is essential before exploring any potential connections between liver health and skin inflammation. Both conditions can significantly impact quality of life and may require long-term management strategies tailored to individual circumstances.
Further information:
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NHS: Non-alcoholic fatty liver disease (NAFLD)
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British Liver Trust: NAFLD patient information
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NHS: Atopic eczema (atopic dermatitis)
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British Association of Dermatologists (BAD): Patient information on atopic eczema
Can Fatty Liver Disease Cause or Trigger Eczema?
There is no established direct causal link between fatty liver disease and eczema according to current medical evidence and UK clinical guidance. These conditions develop through distinct pathophysiological mechanisms, and having fatty liver disease does not directly cause eczema to develop. Eczema is primarily an immune-mediated inflammatory skin disorder with strong genetic components, whilst fatty liver disease is a metabolic condition affecting hepatic function. Neither NICE guidance on NAFLD (NG49) nor British Association of Dermatologists guidance on atopic dermatitis recognises fatty liver disease as a trigger or cause of eczema.
However, observational research has noted potential indirect associations worth understanding, though these do not imply causation. Both conditions may share certain risk factors and can be influenced by systemic inflammation. Some studies have indicated that people with NAFLD often have elevated levels of inflammatory markers such as C-reactive protein (CRP) and various cytokines. Since eczema is also an inflammatory condition, researchers have explored whether systemic inflammation might create an environment where both conditions could coexist. The evidence remains observational and does not support a causal relationship or change current clinical practice.
Metabolic syndrome, which frequently accompanies NAFLD, encompasses insulin resistance, obesity, dyslipidaemia, and hypertension. Some observational studies have noted higher rates of atopic conditions, including eczema, in individuals with metabolic syndrome, though the relationship remains complex and not fully understood. It is important to emphasise that correlation does not imply causation—people may have both conditions coincidentally due to shared lifestyle factors, genetic predispositions, or common inflammatory pathways.
Currently, no official clinical guidance from NICE, the British Association of Dermatologists, or other UK medical bodies recognises fatty liver disease as a trigger or cause of eczema. If you have both conditions, they should be managed independently according to established, evidence-based treatment protocols for each, whilst considering your overall health profile and any shared risk factors that might benefit from lifestyle modifications. 'Liver detox' regimens or unproven supplements marketed to treat eczema by 'cleansing the liver' are not supported by evidence and are not recommended.
Further information:
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NICE NG49: Non-alcoholic fatty liver disease (assessment and management)
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British Association of Dermatologists: Guidelines and patient information on atopic dermatitis
The Link Between Liver Health and Skin Conditions
The liver plays a crucial role in maintaining overall health, including skin integrity. As the body's primary detoxification organ, the liver processes toxins, metabolises medications, produces proteins essential for skin health, and regulates inflammatory responses. When liver function becomes significantly impaired, various skin manifestations can occur, though these typically differ from eczema.
Classical dermatological signs of liver disease include jaundice (yellowing of skin and eyes), spider naevi (small blood vessel clusters on the skin), palmar erythema (reddening of the palms), and pruritus (generalised itching without a primary rash). In advanced liver disease or cirrhosis, patients may develop more severe symptoms. However, fatty liver disease in its early stages rarely produces visible skin changes and typically remains asymptomatic until significant progression occurs. It is important to distinguish eczema—which presents with characteristic eczematous lesions—from generalised pruritus without a primary rash, which may indicate cholestasis or other systemic liver disease and warrants medical evaluation.
The gut–liver–skin axis represents an emerging area of research exploring how liver health, the intestinal microbiome, and skin conditions may interconnect. The liver receives blood directly from the intestines via the portal vein, processing nutrients and filtering bacterial products. Disruption in this system—such as increased intestinal permeability or dysbiosis—has been hypothesised to contribute to systemic inflammation affecting multiple organs, including the skin. However, current evidence for this mechanism is preliminary and observational; it does not change established clinical practice or support specific interventions for eczema based on liver health.
Nutritional deficiencies associated with significant liver dysfunction can affect skin health. The liver stores and processes fat-soluble vitamins (A, D, E, K) and produces proteins necessary for skin barrier function. Whilst mild fatty liver disease typically does not cause significant nutritional deficits, more advanced liver disease can impair absorption and metabolism of these essential nutrients, potentially compromising skin integrity. However, this mechanism would not specifically cause eczema but rather contribute to general skin health deterioration.
Understanding these connections helps contextualise why healthcare professionals consider overall metabolic and hepatic health when managing chronic conditions, even when direct causal relationships have not been established.
Further information:
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NHS: Cirrhosis and liver disease symptoms
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NICE Clinical Knowledge Summaries: Pruritus (assessment and management)
Managing Eczema When You Have Fatty Liver Disease
If you have both fatty liver disease and eczema, a holistic management approach addressing both conditions simultaneously can optimise your overall health. Fortunately, many lifestyle interventions beneficial for fatty liver disease also support general health and may help manage eczema symptoms.
Dietary modifications form the cornerstone of NAFLD management. NICE guidance (NG49) recommends that adults with NAFLD aim for gradual weight loss of 7–10% of body weight, as this has been shown to significantly reduce liver fat, inflammation, and fibrosis. The Mediterranean diet, recommended by NICE for cardiovascular and metabolic health, emphasises fruits, vegetables, whole grains, lean proteins, and healthy fats whilst limiting processed foods, refined sugars, and saturated fats. This anti-inflammatory eating pattern may help reduce systemic inflammation. Omega-3 fatty acids from oily fish (salmon, mackerel, sardines) support liver health; however, evidence for omega-3 supplementation improving eczema is limited and mixed, so benefits for skin should not be overpromised. Ensure adequate hydration to support general wellbeing and skin barrier integrity.
Alcohol guidance is essential for liver health. The UK Chief Medical Officers recommend that both men and women should not regularly drink more than 14 units of alcohol per week, spread over three or more days. If you have alcoholic fatty liver disease (AFLD) or have been advised by your specialist, complete abstinence from alcohol is recommended.
Weight management is crucial for NAFLD. Aim for gradual, sustainable weight loss through balanced nutrition and regular physical activity rather than rapid dieting. Weight loss may also benefit eczema, as obesity is associated with increased inflammatory markers. The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity aerobic activity (such as brisk walking or cycling) per week, plus muscle-strengthening activities on at least two days per week. Regular physical activity supports metabolic health and may help manage stress—a common eczema trigger.
Medication considerations require careful attention when managing both conditions. Some systemic treatments for eczema require regular liver function monitoring. These include:
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Methotrexate (immunosuppressant)
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Azathioprine (immunosuppressant)
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Ciclosporin (immunosuppressant)
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JAK inhibitors (e.g., baricitinib, upadacitinib)
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Alitretinoin (for severe chronic hand eczema)
Long-term oral corticosteroids are generally not recommended for eczema outside short courses under specialist advice, due to significant side effects. Always inform your GP, dermatologist, and any other healthcare professionals about all medications you are taking, including over-the-counter products and supplements. Regular monitoring of liver function tests (including ALT, AST, bilirubin, alkaline phosphatase, albumin, and clotting tests such as INR or prothrombin time) may be necessary if you are prescribed systemic treatments for eczema. Consult the Summary of Product Characteristics (SmPC) for each medicine via the electronic Medicines Compendium (EMC) or discuss monitoring requirements with your prescriber.
Standard eczema management should continue as recommended by your dermatologist or GP, following British Association of Dermatologists guidance. This typically includes regular use of emollients (moisturisers) to maintain skin barrier function, topical corticosteroids or topical calcineurin inhibitors for flare-ups, and identification and avoidance of personal triggers. Most topical preparations have minimal systemic absorption and are generally safe to use with liver conditions.
Stress management and sleep hygiene benefit both conditions. Chronic stress can worsen both fatty liver disease and eczema through inflammatory pathways and behavioural factors. Consider stress-reduction techniques such as mindfulness, yoga, or cognitive behavioural therapy (CBT). Prioritise quality sleep, as poor sleep is associated with metabolic dysfunction and can trigger eczema flares.
Report suspected side effects: If you experience any suspected side effects from your medicines, report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.
Further information:
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NICE NG49: Non-alcoholic fatty liver disease (weight-loss targets and fibrosis assessment)
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UK Chief Medical Officers' Physical Activity Guidelines
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UK Chief Medical Officers' Low Risk Drinking Guidelines
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British Association of Dermatologists: Systemic therapies for atopic dermatitis
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Electronic Medicines Compendium (EMC): SmPCs for systemic eczema therapies
When to See a Doctor About Liver and Skin Symptoms
Seek urgent medical attention (same-day assessment or call 999) if you experience symptoms suggesting serious liver disease complications or acute deterioration:
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Jaundice: yellowing of the skin or whites of the eyes
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New or worsening confusion, drowsiness, or difficulty concentrating (potential sign of hepatic encephalopathy)
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Vomiting blood or passing black, tarry stools (melaena)
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Rapidly worsening jaundice or severe abdominal swelling (ascites)
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Signs of sepsis: high fever, rapid heart rate, confusion, severe weakness
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Persistent abdominal pain or swelling, particularly in the upper right abdomen
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Easy bruising or bleeding that occurs without obvious cause
These symptoms may indicate advancing or decompensated liver disease requiring urgent hospital assessment.
For other liver-related concerns, contact your GP promptly if you experience:
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Unexplained fatigue that significantly impacts daily activities
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Dark urine or pale-coloured stools
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Severe, generalised itching without a visible rash, which may indicate cholestasis rather than eczema
For eczema concerns, consult your GP if:
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Your eczema suddenly worsens or does not respond to usual treatments
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You develop signs of skin infection (increased pain, warmth, swelling, oozing, pus, or fever)
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The condition significantly affects your quality of life, sleep, or mental health
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You experience widespread, severe itching that might be related to liver function rather than eczema
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You are unsure whether skin symptoms relate to eczema or another condition
Regular monitoring is essential when you have fatty liver disease. Your GP should arrange periodic blood tests to assess liver function and metabolic markers. These tests typically include:
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Liver enzymes: alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP)
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Liver function markers: bilirubin, albumin
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Clotting function: INR or prothrombin time
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Full blood count (FBC) and platelet count
Remember that normal liver blood tests do not exclude NAFLD or rule out fibrosis progression, as liver enzymes can be normal even in the presence of significant liver disease.
Fibrosis assessment is recommended by NICE (NG49) for adults with NAFLD. The Enhanced Liver Fibrosis (ELF) test is a blood test used to assess the degree of liver scarring. NICE recommends that:
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Adults with NAFLD should have an ELF test to assess for advanced fibrosis
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An ELF score of 10.51 or above suggests advanced fibrosis and warrants referral to a specialist hepatology service
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Your GP or specialist may also arrange transient elastography (FibroScan), a non-invasive ultrasound-based test, to assess liver stiffness and fat content
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Repeat testing intervals will be determined based on your individual risk factors and disease severity
The frequency of monitoring depends on your individual risk factors, disease severity, and whether you are on systemic treatments for eczema that require liver function monitoring.
Coordinate your care by ensuring all healthcare professionals involved in your treatment are aware of both conditions. Your GP can serve as the central coordinator, but you may also see dermatologists for eczema and hepatologists for liver disease. Bring a current medication list to all appointments, including over-the-counter products and supplements, as some may affect liver function or interact with eczema treatments.
If you are concerned about potential connections between your liver health and skin symptoms, discuss these concerns with your GP. Whilst there is no established direct link, your doctor can assess your individual situation, review relevant investigations, and provide personalised advice. They can also refer you to appropriate specialists if needed and ensure you receive evidence-based management for both conditions. Early intervention and consistent monitoring optimise outcomes for both fatty liver disease and eczema, helping you maintain the best possible quality of life.
Further information:
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NICE NG49: Non-alcoholic fatty liver disease (ELF testing and referral thresholds)
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NHS: NAFLD symptoms and when to see a GP
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NHS: Atopic eczema—when to get medical help
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British Society of Gastroenterology: Guidance on abnormal liver blood tests
Frequently Asked Questions
Can having fatty liver disease make my eczema worse?
There is no established evidence that fatty liver disease directly worsens eczema. Both conditions may share certain risk factors such as systemic inflammation and metabolic syndrome, but they develop through distinct mechanisms and should be managed independently according to evidence-based protocols for each condition.
What skin problems does fatty liver actually cause?
Early-stage fatty liver disease typically causes no visible skin changes and remains asymptomatic. Advanced liver disease or cirrhosis may cause jaundice (yellowing of skin and eyes), spider naevi (small blood vessel clusters), palmar erythema (reddened palms), and generalised itching without a primary rash, which differs from the characteristic eczematous lesions of atopic dermatitis.
Is it safe to take eczema medication if I have fatty liver disease?
Most topical eczema treatments are safe with fatty liver disease, but systemic medications including methotrexate, azathioprine, ciclosporin, JAK inhibitors, and alitretinoin require regular liver function monitoring. Always inform your GP and dermatologist about your liver condition so they can prescribe safely and arrange appropriate blood test monitoring.
Will losing weight help both my fatty liver and eczema?
Gradual weight loss is highly beneficial for fatty liver disease, with NICE recommending 7–10% body weight reduction to significantly reduce liver fat and inflammation. Whilst weight loss may help reduce systemic inflammation that could indirectly benefit eczema, it is not a primary treatment for eczema, which requires specific dermatological management including emollients and topical therapies.
Should I avoid certain foods if I have both conditions?
For fatty liver disease, NICE recommends a Mediterranean diet emphasising fruits, vegetables, whole grains, lean proteins, and healthy fats whilst limiting processed foods, refined sugars, and saturated fats. There is no specific dietary restriction for eczema unless you have identified personal food triggers, though an anti-inflammatory eating pattern may support overall health and reduce systemic inflammation.
When should I see a doctor about itchy skin with fatty liver?
Seek urgent medical attention if you develop jaundice, severe generalised itching without a visible rash (which may indicate cholestasis rather than eczema), confusion, vomiting blood, or severe abdominal pain. Contact your GP promptly for unexplained fatigue, dark urine, pale stools, or if your eczema suddenly worsens or shows signs of infection such as increased pain, warmth, oozing, or fever.
The health-related content published on this site is based on credible scientific sources and is periodically reviewed to ensure accuracy and relevance. Although we aim to reflect the most current medical knowledge, the material is meant for general education and awareness only.
The information on this site is not a substitute for professional medical advice. For any health concerns, please speak with a qualified medical professional. By using this information, you acknowledge responsibility for any decisions made and understand we are not liable for any consequences that may result.
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