Detoxification Series: The Liver

The liver is a vital organ for detoxification

Credits: aedrozda at
Edited By:
Raja Sivamani , MD, MS, AP

What’s the Liver Got to Do with it?

The liver is an essential organ and performs over 500 vital functions in the body including production, storage, and metabolism of various compounds required for the body to operate day-to-day.[1] Proper liver function is important for maintaining good health and glowing skin. The focus of this series is detoxification, so let’s look at the role the liver plays in detoxification and how to support liver detoxification as a component of holistic dermatologic treatment.


Phases of Detoxification

Remember the term biotransformation? This is the process by which a substance (drug, hormone, chemical) is altered to make it easier for the body to excrete. There are two phases of biotransformation.[1] Phase I is the cytochrome phase. Cytochrome enzyme systems are a group of enzymes that transform compounds through oxidation, reduction, or hydrolysis to make the compounds more water-soluble. Phase II is the conjugation phase. At this step, the substance is conjugated through sulfation, glucuronidation, or acetylation to make the compound even more water-soluble and easier to excrete. Excretion is the final step, sometimes referred to as phase III.


Warning: Detoxification Produces Toxins

It is important to note that even though one might assume detoxification would always result in a toxic substance turning into a less toxic substance, the process of detoxification can actually yield harmful metabolites and free radicals. After phase I of biotransformation, the intermediate substance may be more toxic or active than the original substance.[1] Also, the process of transformation in phase I naturally creates peroxide and free radicals.[1] Thus, biochemical detoxification is complex and requires balance as well as plenty of antioxidants. For example, if phase I is working properly but phase II is impaired, oxidative damage occurs and toxins may accumulate rather than be eliminated. Phase II is essential for complete detoxification, and Phase III is essential for removal of toxins.


Liver Connection to Skin Conditions

Research is clear that impaired liver function is associated with various skin conditions including jaundice, psoriasis, and atopic dermatitis (eczema).[2,3] A Japanese study of infants with atopic dermatitis used a common breath test to evaluate liver function and demonstrated significantly lower hepatic clearance of the test substance compared to normal controls.[3] If skin disorders are associated with poor liver function, it may be postulated the converse also holds true - healthy skin is associated with healthy liver function - and improving liver function would potentially improve skin conditions. Another way the liver is connected to skin health is through hormones - the liver produces and metabolizes hormones. Hormones directly affect skin health. For example, higher levels of testosterone, progesterone, and insulin are seen in patients with acne vulgaris.[4] Liver function influences hormone levels and activity.


Skin Detoxification

The liver is where most biotransformation occurs, however, we also now know that biotransformation happens in cells throughout the body, including the skin. In fact, skin is the largest metabolizer of drugs and chemicals outside of the liver.[5] Despite a lack of studies to directly show improving detoxification function will change skin conditions, there are clear correlations between skin health and detoxification pathways. Anecdotally many patients report improved skin quality and appearance during or after a cleanse. In some cases, the body may react with skin rashes or flares as the body detoxifies. Keep reading for practical steps to detoxify for better skin health.


How to Optimize Liver Function & Detoxification

  1. Remember that detoxification is a daily process. Make daily choices to eat foods that support detoxification, especially fruits, vegetables, herbs, and spices.[6] Decrease intake of toxins by avoiding chemicals in the air, water, and food (more to come on this topic in a future article).
  2. Add liver supportive supplements. Enzymes are responsible for phase I and phase II detoxification. Enzyme activity is influenced by genetic mutations and gene expression, as well as by chemicals and drugs that are inhibitors or inducers of the enzymes.[7] When using the term “liver support,” usually this is referring to vitamins, minerals, or herbs that effectively induce or influence the enzymes involved in biotransformation, thus increasing liver detoxification.[8] For example, supplementing with an extract from broccoli sprouts rich in the compound sulforaphane has been shown to improve liver function and increase phase II detoxification.[9] Dietary supplements should be prescribed or monitored by a qualified healthcare practitioner.
  3. Improve the elimination of toxins via hydration (kidneys), sweating and exfoliating (skin), deep breathing (lungs), good digestion and regular bowel movements (colon). Bile and stool are one of the main ways bio-transformed products are finally excreted. It is crucial to have regular bowel movements to prevent recirculation of toxins.
  4. Consider a detoxification program or cleanse. Avoid any products or programs making exaggerated claims. Detoxification programs should be prescribed or monitored by a qualified healthcare practitioner.


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  1. Grant DM. Detoxification pathways in the liver. J Inherit Metab Dis.1991;14(4):421-430; PMID: 1749210 Link to research.
  2. Cassano N, Vestita M, Apruzzi D, et al. Alcohol, psoriasis, liver disease, and anti-psoriasis drugs. Int J Dermatol.2011;50(11):1323-1331; PMID: 22004481 Link to research.
  3. Iikura Y, Iwasaki A, Tsubaki T, et al. Study of liver function in infants with atopic dermatitis using the 13C-methacetin breath test. Int Arch Allergy Immunol.1995;107(1-3):189-193; PMID: 7613128 Link to research.
  4. Arora MK, Yadav A, Saini V. Role of hormones in acne vulgaris. Clin Biochem.2011;44(13):1035-1040; PMID: 21763298 Link to research.
  5. Manevski N, Swart P, Balavenkatraman KK, et al. Phase II metabolism in human skin: skin explants show full coverage for glucuronidation, sulfation, N-acetylation, catechol methylation, and glutathione conjugation. Drug Metab Dispos.2015;43(1):126-139; PMID: 25339109 Link to research.
  6. Hodges RE, Minich DM. Modulation of Metabolic Detoxification Pathways Using Foods and Food-Derived Components: A Scientific Review with Clinical Application. J Nutr Metab.2015;2015:760689; PMID: 26167297 Link to research.
  7. Trusov NV, Guseva GV, Beketova NA, et al. [Effects of vitamins deficiency on the cytochrome P450 inducibility in rats]. Vopr Pitan.2014;83(3):4-11; PMID: 25300103 Link to research.
  8. Jandacek RJ, Tso P. Factors affecting the storage and excretion of toxic lipophilic xenobiotics. Lipids.2001;36(12):1289-1305; PMID: 11834080 Link to research.
  9. Kikuchi M, Ushida Y, Shiozawa H, et al. Sulforaphane-rich broccoli sprout extract improves hepatic abnormalities in male subjects. World J Gastroenterol.2015;21(43):12457-12467; PMID: 26604653 Link to research.