Many liver disease treatments address the liver itself but don’t quite treat your symptoms. Primary biliary cholangitis (PBC) supportive therapies help manage uncomfortable problems like itchy skin and dry mouth and eyes. But how do you know which treatments are right for you?

This article covers five new supportive therapies for PBC that you can try at home to improve your quality of life. Your doctor can also make suggestions to include along with your PBC medications.

What Is PBC and How Is It Treated?

PBC is a progressive liver condition that causes inflammation and scar tissue buildup. In PBC, inflammation destroys the bile ducts in the liver. This prevents bile from moving through the liver — causing it to build up. Eventually, the organ has too much scar tissue and doesn’t work properly.

Doctors typically treat PBC with medications that help slow disease progression. The U.S. Food and Drug Administration has approved four treatments for PBC. They include:

• Ursodeoxycholic acid (UDCA or Ursodiol)
• Elafibranor (Iqirvo)
• Seladelpar (Livdelzi)
• Obeticholic acid (Ocaliva)

These medications help move bile from the liver into the small intestine. Other medications and treatments may be used off-label for PBC.

Supportive Therapies for PBC

While treatments like UDCA and obeticholic acid help treat the underlying cause of PBC, they don’t always help manage symptoms. Your doctor may recommend supportive therapies to help make you more comfortable with PBC. These treatments “support” your other PBC medications and improve your overall quality of life.

Following are five supportive therapies for PBC.

1. Antihistamines for Itchy Skin

People with PBC often have intensely itchy skin (pruritus). This is one of the most common symptoms of the disease. Researchers aren’t quite sure why those with liver diseases experience itching — but they have a few ideas.

Since PBC destroys the bile ducts, bile backs up in the liver and leaks into the body. Researchers think itchiness may be caused by high levels of bile salts in the bloodstream irritating nerves. Itchy skin can also be due to more chemicals in the blood from liver damage, like alkaline phosphatase (ALP) or histamine.

Immune cells release histamine when you come into contact with an allergen, like pollen or dust. Histamine triggers an allergic response to help clear the allergen out of your body. You may have a runny nose, watery eyes, and itchy skin.

Luckily, medications called antihistamines help counteract this response. You might even have these allergy pills in your medicine cabinet now. Examples include:

• Diphenhydramine (Benadryl)
• Fexofenadine (Allegra)
• Cetirizine (Zyrtec)
• Loratadine (Claritin)

People with PBC can take antihistamines to treat their itchy skin. Australia’s Liver Foundation also recommends that you avoid itching and scratching your skin.

Other tips to relieve itching include:

• Use cool or lightly warm water when bathing and showering. (Hot water dries out the skin and can make itching worse.)
• Choose gentle, fragrance-free soaps and moisturizers.
• Wear loose clothing that won’t rub against sensitive skin.
• Use a cold, wet cloth to calm itchy skin, especially when you’re hot.

2. Cholestyramine for Itchy Skin

Your doctor may also recommend cholestyramine to relieve your itchy skin. This medication helps your body clear out bile acids that can cause itchiness. It binds to certain substances in the intestine. Because your body can’t absorb cholestyramine, when the medication leaves your body, it takes some bile acids with it.

Cholestyramine comes as a powder in premeasured packets. You should mix the powder with a drink of your choice, like water, juice, or milk. Be sure to read the instructions to make sure you add enough liquid.

3. Artificial Tears for Dry Eyes

Another common symptom of PBC is dry eyes. People with PBC are more likely to have Sjögren’s syndrome. This is an autoimmune disease that affects moist membranes like the eyes and mouth. People with both PBC and Sjögren’s syndrome may notice their eyes are drier than normal.

Your doctor may recommend trying eye drops or artificial tears to moisten your eyes. Most brands can be found over the counter at your local pharmacy. There are also gels available to use at nighttime.

If you have Sjögren’s syndrome, Johns Hopkins Medicine recommends other strategies for managing dry eyes and inflammation, including:

• Wear goggles or sunglasses while outside to protect your eyes from air, wind, and dust.
• Ask your doctor about prescription eye drops.
• For more serious cases, talk to your doctor about punctal occlusion. This simple procedure blocks your tear ducts to keep tears in your eyes for extra moisture.

4. Saliva Substitutes for Dry Mouth

Another symptom of PBC — especially in people with Sjögren’s syndrome — is dry mouth. Liver diseases and some treatments can affect how much saliva you make. Without enough saliva to wet your mouth, you can experience some discomfort. Symptoms of dry mouth include:

• Increased thirst
• A persistent sore throat
• Bad breath
• Sores on your tongue, lips, or inside your mouth
• Trouble eating, swallowing, tasting, and speaking
• Cavities from tooth decay

The Mayo Clinic recommends trying over-the-counter saliva substitutes to treat dry mouth. Look on the label for xylitol or hydroxyethyl cellulose. These ingredients are found in popular saliva substitutes like Biotene Dry Mouth and Mouth Kote. Be sure to follow the instructions closely. Also, keep in mind that xylitol can cause stomach cramping and diarrhea in some people.

Other tips for relieving your dry mouth include:

• Suck on sugar-free hard candies or chew sugar-free gum.
• Use mouthwashes for treating dry mouth that contain xylitol.
• Limit caffeinated beverages.
• Stop smoking and using chewing tobacco.
• Use a humidifier in your bedroom at night to add moisture to the air.
• Sip water throughout the day to moisten your mouth.

5. Good Nutrition and Vitamins

When living with PBC, it’s important to follow a healthy diet high in key vitamins and nutrients. Many people with this liver disease have a hard time absorbing vitamins A, D, E, and K. They’re known as fat-soluble vitamins, and you need bile salts to move them into the intestines. Because PBC destroys your bile ducts and blocks bile flow, you may not get enough fat-soluble vitamins.

Your doctor may recommend following the Mediterranean diet. This dietary plan incorporates plenty of fruits, veggies, whole grains, and healthy fats. Try getting fat-soluble vitamins from fruits and veggies rather than high-fat meats or dairy products.

Whole grains are high in fiber and help prevent fatty liver disease. Choose whole-grain bread and brown rice instead of white bread and rice. Fruits and veggies are loaded with fiber as well.

Saturated fats like omega-3 fatty acids are easier for your body to digest. This takes extra work away from your liver, which may help people with PBC. Try adding foods high in omega-3s to your diet. These include salmon, chia seeds, olive oil, and avocados.

Find Your Team

On myPBCteam, the social network for people with primary biliary cholangitis and their loved ones, more than 1,500 members come together to ask questions, give advice, and share their tips with others who understand life with primary biliary cholangitis.

Have you been diagnosed with primary biliary cholangitis? Which supportive therapies have you tried? Do you have others to recommend? Share your experiences and suggestions in the comments below, or start a conversation by posting on your Activities page.