title: Cholestatic Itch Management.
abstract: Cholestatic itch is a feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, the inherited form of cholestasis, and intrahepatic cholestasis of pregnancy. Although undervalued by physicians, cholestatic itch can be a source of great discomfort to the patient and significantly affects quality of life. Many pruritogens such as bile salts, opioids, serotonin, and histamine have been implicated in the pathogenesis of cholestatic itch, but no causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may be key elements in its pathogenesis. Treatment options for patients with cholestatic itch include the anion exchange resin cholestyramine, bile acid ursodeoxycholic acid, PXR agonist rifampicin, opioid antagonist naltrexone, and the serotonin inhibitor sertraline. These drugs can be used as a stepwise therapeutic approach. The body of evidence for many of these options, however, is not very robust. Patients who do not respond to medical therapy can be candidates for interventional measures, such as albumin dialysis, plasmapheresis, or nasobiliary drainage, or certain experimental approaches such as UVB phototherapy. Research over the past decade has elucidated many of the receptors and neuropeptides involved in itch sensation and transmission; it is hoped that in the future this will lead to the development of novel antipruritic medication for cholestatic itch.
authors: Department of Dermatology, RNT Medical College and Associate Hospitals, Udaipur, India.
authors: Asit
authors: A
authors: Mittal
mesh_terms: D000837:Anion Exchange Resins / Q000627:therapeutic use*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D002779:Cholestasis / Q000150:complications / Q000378:metabolism / Q000628:therapy*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D006801:Humans; D008246:Lysophospholipids / Q000378:metabolism; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D010956:Plasmapheresis; D000077297:Pregnane X Receptor; D011537:Pruritus / Q000209:etiology / Q000628:therapy*; D011987:Receptors, Steroid / Q000819:agonists; D012293:Rifampin / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use; D014467:Ultraviolet Therapy; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D000837:Anion Exchange Resins; D002756:Cholagogues and Choleretics; D002792:Cholestyramine Resin; D008246:Lysophospholipids; D009271:Naltrexone; D009292:Narcotic Antagonists; D000077297:Pregnane X Receptor; D011987:Receptors, Steroid; D012293:Rifampin; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline; D014580:Ursodeoxycholic Acid; C032881:lysophosphatidic acid