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Cholestasis associated PruritusAka: Pruritus associated with Cholestatic Liver Disease

See Also
1. Pruritus
Pathophysiology
1. Bile salt protease release in skin and plasma
Causes: Cholestasis
1. Chronic Liver Disease
2. Pancreatic carcinoma
3. Primary biliary Cirrhosis (Pruritus in all cases)
4. Intrahepatic Cholestasis of Pregnancy
  1. Affects 0.5% of women in third trimester
Symptoms: Pruritus
1. Intense itching worse at night
2. Location (initial)
  1. Hands and feet
  2. Pressure areas
Signs
1. Hyperpigmentation in areas of heavy scratching
2. Spares midback resulting in butterfly-shaped rash
Management
1. Cholestyramine (or Colestipol if Constipation limited)
  1. Has also been used in Pruritus of pregnancy
2. Ursodeoxycholic Acid
  1. Used in primary biliary Cirrhosis (intense itch)
3. Ultraviolet Radiation
  1. May be indicated in refractory cases
4. Ondansetron
5. Opiate receptor antagonist
  1. Naloxone IV
  2. Nalmefene PO
References
1. Bergasa (1999) J Am Acad Dermatol 41:431

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This page was written by Scott Moses, MD. This page was last revised on 4/26/2008 9:13:08 PM. This page was last published on 4/29/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.