Chronic hepatitis is characterized by ongoing inflammation of the liver and destruction (necrosis) of liver cells that persists for more than six to 12 months. Symptoms may be mild, vague, or nonexistent. Chronic hepatitis may progress slowly and can subside spontaneously over months or even years.

In some patients, it can be a more dangerous condition because the destruction of liver cells results in the development of scar tissue in the liver (cirrhosis) and may ultimately lead to liver failure. Therapy sometimes can cure the disease or retard its progression.

What Causes Chronic Hepatitis?

  • An acute infection of hepatitis B or C may develop into chronic hepatitis.
  • Years of excessive alcohol consumption may lead to chronic hepatitis.
  • Autoimmune disorders (in which the immune system attacks body tissues) and, rarely, metabolic disorders (such as iron accumulation in the liver or Wilson’s disease, in which excess amounts of copper are stored in the liver; see Wilson’s disease for more information) may be causes.
  • In rare instances some medications, such as dantrolene, nitrofurantoin, and the sulfonamides, may lead to chronic hepatitis.
  • In some cases the cause is unknown.

Symptoms of Chronic Hepatitis

  • General discomfort
  • Joint pain
  • Fatigue or tiredness
  • Loss of appetite
  • Nausea and vomiting
  • Jaundice (yellowish tinge to the eyes and skin)
  • Small, red, spidery veins on the surface of the skin (called spider telangiectasias or spider angiomas)
  • Pain or tenderness in the upper right abdomen
  • Abdominal swelling caused by fluid accumulation (when cirrhosis develops)
  • Fever
  • Enlarged liver
  • Gray or pale-colored stools
  • Dark urine
  • In women (especially when autoimmune chronic hepatitis is involved): cessation of menstruation (amenorrhea), acne, the appearance of male-pattern facial hair (hirsutism), and joint pain.

Preventing Chronic Hepatitis

  • Consume no more than two alcoholic drinks a day. If you suspect that you may have a drinking problem, seek help at once.
  • A hepatitis B vaccination is recommended for those at high risk, such as health-care workers, and before traveling to areas where hepatitis is common.

Chronic Hepatitis Diagnosis

  • Patient history and physical examination
  • Specific blood tests for hepatitis B and C.
  • A liver biopsy (removal of a tissue sample for microscopic examination) is almost always necessary for an accurate diagnosis.

How to Treat Chronic Hepatitis

  • Do not consume alcoholic beverages.
  • Corticosteroids, with or without an immunosuppressant drug such as azathioprine, may be prescribed to treat cases of autoimmune chronic hepatitis.
  • Alpha-interferon in combination with ribavirin may be prescribed to treat chronic hepatitis caused by the hepatitis C virus.
  • Lamivudine or alpha-interferon may be used to treat hepatitis B.
  • Your doctor may change your prescription(s) to relieve hepatitis caused by medications.
  • Lifelong treatment of any underlying metabolic disorder (such as Wilson’s disease) is necessary.
  • Liver transplantation may be recommended when the liver has been severely damaged.

When to Call a Doctor

  • Call a doctor if you develop symptoms of chronic hepatitis.
  • Call a doctor if you have had jaundice or an acute hepatitis infection and symptoms persist despite treatment.


Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference

Simeon Margolis, M.D., Ph.D., Medical Editor

Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50

Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 23 Aug 2011

Last Modified: 07 Nov 2014