Management of Chronic Hepatic Itch

Dermatol Clin. 2018 Jul;36(3):293-300. doi: 10.1016/j.det.2018.02.008. Epub 2018 May 1.

Abstract

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.

Keywords: Autotaxin; Bile salt; Cholestasis; Liver; Lysophosphatidic acid; Management; Pruritus.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Anion Exchange Resins / therapeutic use
  • Antipruritics / therapeutic use*
  • Bezafibrate / therapeutic use
  • Carrier Proteins / antagonists & inhibitors
  • Cholagogues and Choleretics / therapeutic use
  • Cholestasis / complications*
  • Cholestasis / etiology
  • Cholestasis / surgery
  • Cholestyramine Resin / therapeutic use
  • Chronic Disease
  • Cytochrome P-450 Enzyme Inducers / therapeutic use
  • Drainage
  • Humans
  • Hypolipidemic Agents / therapeutic use
  • Membrane Glycoproteins / antagonists & inhibitors
  • Methylamines / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Prevalence
  • Pruritus / epidemiology
  • Pruritus / physiopathology*
  • Pruritus / therapy*
  • Rifampin / therapeutic use
  • Thiazepines / therapeutic use
  • Ursodeoxycholic Acid / therapeutic use

Substances

  • 3-((((3R,5R)-3-butyl-3-ethyl-7-(methyloxy)-1,1-dioxido-5-phenyl-2,3,4,5-tetrahydro-1,4-benzothiazepin-8-yl)methyl)amino)pentanedioic acid
  • Analgesics, Opioid
  • Anion Exchange Resins
  • Antipruritics
  • Carrier Proteins
  • Cholagogues and Choleretics
  • Cytochrome P-450 Enzyme Inducers
  • Hypolipidemic Agents
  • Membrane Glycoproteins
  • Methylamines
  • Narcotic Antagonists
  • Thiazepines
  • bile acid binding proteins
  • Cholestyramine Resin
  • Ursodeoxycholic Acid
  • Rifampin
  • Bezafibrate