title: Pilot study of bright-light therapy reflected toward the eyes for the pruritus of chronic liver disease.
abstract: OBJECTIVE
  It is proposed that the pruritus of cholestasis is, in part, centrally mediated by endogenous opioid peptides. The expression of these peptides and their receptors on neurons displays a circadian rhythm, as does the scratching activity in patients with cholestasis and pruritus. Because light has regulatory effects on circadian rhythms via retinothalamic pathways, we hypothesized that bright-light therapy (BLT) reflected toward the eyes might alter the pruritus of cholestasis. To test this hypothesis, we studied the effect of BLT on this form of pruritus.
  
  
  METHODS
  Eight patients with chronic liver disease of different etiologies and pruritus were studied in an open-label, pilot study of 8-wk duration. BLT (10,000 lux) was administered for up to 60 min twice a day. Pruritus was assessed subjectively by a visual analog scale from which a visual analog score (VAS) was derived, and objectively, by a scratching activity monitoring system that recorded hourly scratching activity (HSA).
  
  
  RESULTS
  In seven of the eight patients studied, the mean HSA was lower during BLT. BLT was associated with a mean decrease in HSA of 32.2% (p = 0.123). The mean VAS for pruritus was lower in six patients during BLT; the mean VAS score derived from the eight patients studied decreased by 42% (p = 0.05) during treatment.
  
  
  CONCLUSIONS
  The results of this short-term study suggest that the pruritus of cholestasis is responsive to bright light reflected toward the eyes and that in some patients, BLT may ameliorate this form of pruritus.
authors.affiliation: Department of Psychiatry, Beth Israel Medical Center, The Rockefeller University Hospital, New York, New York, USA.
authors.forename: N V
authors.initials: NV
authors.lastname: Bergasa
authors.forename: M J
authors.initials: MJ
authors.lastname: Link
authors.forename: M
authors.initials: M
authors.lastname: Keogh
authors.forename: G
authors.initials: G
authors.lastname: Yaroslavsky
authors.forename: R N
authors.initials: RN
authors.lastname: Rosenthal
authors.forename: M
authors.initials: M
authors.lastname: McGee
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005123:Eye / Q000528:radiation effects*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010789:Phototherapy; D010865:Pilot Projects; D011537:Pruritus / Q000209:etiology* / Q000503:physiopathology / Q000532:radiotherapy*; D012720:Severity of Illness Index