Management of Chronic Hepatic Itch

Hepatic itch remains among the most agonizing symptoms for affected patients and a major clinical challenge for physicians. Pruritus may occur in almost all liver diseases, particularly those with cholestatic features. Hepatic itch arises irrespective of the severity of the underlying liver disease...

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Bibliographic Details
Published inDermatologic clinics Vol. 36; no. 3; pp. 293 - 300
Main Authors Düll, Miriam M., MD, Kremer, Andreas E., MD, PhD, MHBA
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.07.2018
Subjects
Analgesics, Opioid - therapeutic use
Anion Exchange Resins - therapeutic use
Antipruritics - therapeutic use
Autotaxin
Bezafibrate - therapeutic use
Bile salt
Carrier Proteins - antagonists & inhibitors
Cholagogues and Choleretics - therapeutic use
Cholestasis
Cholestasis - complications
Cholestasis - etiology
Cholestasis - surgery
Cholestyramine Resin - therapeutic use
Chronic Disease
Cytochrome P-450 Enzyme Inducers - therapeutic use
Dermatology
Drainage
Humans
Hypolipidemic Agents - therapeutic use
Liver
Lysophosphatidic acid
Management
Membrane Glycoproteins - antagonists & inhibitors
Methylamines - therapeutic use
Narcotic Antagonists - therapeutic use
Prevalence
Pruritus
Pruritus - epidemiology
Pruritus - physiopathology
Pruritus - therapy
Rifampin - therapeutic use
Thiazepines - therapeutic use
Ursodeoxycholic Acid - therapeutic use
Lysophosphatidic acid
Bile salt
Autotaxin
Liver
Management
Pruritus
Cholestasis
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Summary:Hepatic itch remains among the most agonizing symptoms for affected patients and a major clinical challenge for physicians. Pruritus may occur in almost all liver diseases, particularly those with cholestatic features. Hepatic itch arises irrespective of the severity of the underlying liver disease or extent of cholestasis. Antihistamines are ineffective in hepatic itch. Therapeutic recommendations consist of a guideline-based stepwise approach, starting with the anion exchange resin cholestyramine, followed by rifampicin, naltrexone, and sertraline. Bezafibrate and ileal bile acid transporter inhibitors are promising future treatment options. Experimental and invasive procedures should be reserved for refractory pruritus.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
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ObjectType-Review-1
ISSN:0733-8635
1558-0520
DOI:10.1016/j.det.2018.02.008