Refractory pruritus in primary biliary cirrhosis.
Pruritus is a major symptom of primary biliary cirrhosis, cholestatic autoimmune disease which affects mostly middle-age women. Often, it can be severe and refractory to multiple treatments, and mostly affecting the patient's health-related quality of life. Intense pruritus can be itself an indication to liver transplantation, in extreme cases leading to suicide. Its physiopathology has not yet been fully elucidated, but recent studies added the elevation of autotaxin and lysophosphatidic acid to the group of classic mechanisms already linked to cholestatic pruritus. In this case report we illustrate how ultraviolet B phototherapy appears to successfully control severe pruritus and contribute to the healing of pruritic skin lesions caused by intense scratching. There is limited medical literature concerning this therapeutic approach on cholestatic pruritus, but we hope that further randomised controlled trials will successfully establish it as an effective treatment in the near future.
Serviço de Medicina I, Hospital Egas Moniz, Lisbon, Portugal.
Nuno Cercas
NC
Pinheiro
Rui Tato
RT
Marinho
Fernando
F
Ramalho
José
J
Velosa
D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000150:complications*; D008875:Middle Aged; D011537:Pruritus / Q000209:etiology* / Q000473:pathology / Q000532:radiotherapy; D012867:Skin / Q000473:pathology / Q000528:radiation effects; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods