Refractory Pruritus in Advanced Liver Disease: Exploring the Overlooked Role of Basic Emollient Care

Pruritus is a prevalent yet frequently under-recognized symptom of chronic liver disease.Symptom control becomes particularly challenging in palliative care, where treatment is limited by frailty, comorbidity, and a shift in focus from cure to comfort.We present a 70-year-old woman with decompensated alcohol-related liver disease and long-standing chronic pruritus who was admitted following a fall and subsequently transitioned to palliative care.Her pruritus markedly worsened during admission and improved partially with antihistamines and levomepromazine.Liver disease was considered the leading cause.Opioid therapy, dehydration, and disruption of her usual skin-care routine were considered contributing factors.Collateral history established that her pruritus had previously been managed at her care home with regular emollients, a regimen that was applied less consistently following admission.Dermatological assessment found no primary skin condition.The most noticeable improvement followed the reinstatement of intensive emollient therapy, although her symptoms fluctuated and never fully resolved.This case suggests that treatmentrefractory pruritus at the end of life may sometimes reflect a lapse in basic supportive care rather than disease progression alone.It also highlights the value of collateral history and combined palliative and dermatological assessment in managing these patients.