title: Cholestasis-induced pruritus treated with ultraviolet B phototherapy: an observational case series study.
abstract: OBJECTIVE
  Pruritus is a disabling complication of cholestatic liver disorders. Its management remains challenging. Ultraviolet B (UVB) phototherapy has been successfully used to treat pruritus in other indications.
  
  
  METHODS
  This is an observational case series. The study population consists of 13 patients (10 females, mean age 52 years) with pruritus due to different cholestatic liver disorders: PBC (n=4), PSC (n=2), drug-induced (n=3) and persistent cholestasis after liver transplantation (LT) (n=4). Serum alkaline phosphatase levels were: 686 ± 363 μ/L and serum bile acids levels: 147 ± 15 μmol/L. In all patients, conventional medical treatment had failed to control pruritus. Perception of pruritus was recorded by the visual analogue scale (VAS).
  
  
  RESULTS
  The mean follow-up was 3 years. Ten patients (77%) had more than 60% reduction in perceived pruritus of which 4 had more than an 80% reduction. Median [25-75% percentiles] VAS score before and after treatment decreased from 8.0 [8.0-10] to 2.0 [1.5-2.1] (p<0.001). The mean number of irradiations required to obtain this effect was 26 ± 17 (average duration of phototherapy: 8 weeks). No significant changes in cholestatic serum markers were observed. Four patients (30%) needed an additional phototherapy course because of recurrent pruritus and in all of them again a marked improvement of pruritus was observed. The therapy was well tolerated, except in two patients who developed, during retreatment, pronounced erythema in one case and paresthesia in the other case.
  
  
  CONCLUSIONS
  UVB phototherapy appears to be a promising and well tolerated treatment also for cholestasis-associated pruritus.
authors.affiliation: Department of Hepatology, University Hospital Gasthuisberg, KU Leuven, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Decock
authors.forename: Rik
authors.initials: R
authors.lastname: Roelandts
authors.forename: Werner Van
authors.initials: WV
authors.lastname: Steenbergen
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.forename: David
authors.initials: D
authors.lastname: Cassiman
authors.forename: Chris
authors.initials: C
authors.lastname: Verslype
authors.forename: Johan
authors.initials: J
authors.lastname: Fevery
authors.forename: Jos Van
authors.initials: JV
authors.lastname: Pelt
authors.forename: Frederik
authors.initials: F
authors.lastname: Nevens
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001647:Bile Acids and Salts / Q000097:blood; D002779:Cholestasis / Q000150:complications; D004890:Erythema / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010292:Paresthesia / Q000209:etiology; D011537:Pruritus / Q000097:blood / Q000209:etiology / Q000532:radiotherapy*; D012008:Recurrence; D012720:Severity of Illness Index; D014467:Ultraviolet Therapy / Q000009:adverse effects
chemical_list: D001647:Bile Acids and Salts; D000469:Alkaline Phosphatase