Cholestasis-Associated Pruritus and Its Pruritogens
Jacqueline A. G. M. Langedijk, Ulrich H. Beuers and Ronald P. J. Oude Elferink* published March 9, 2021, frontiers in Medicine.
“Cholestasis is the term for diminished or impaired bile flow generated by hepatocytes and
cholangiocytes. The cause of cholestasis can be intra- or extrahepatic, and can be genetic or the
consequence of an inflammatory or malignant hepatobiliary disease. Next to fatigue, pruritus is
the most frequent symptom in patients with chronic cholestatic disorders and may affect more
than half of patients with fibrosing cholangiopathies such as primary biliary cholangitis (PBC) or
primary sclerosing cholangitis (PSC) at least transiently during their disease course. Depending on
the cause of cholestasis, 30–90% of patients suffer from chronic pruritus, which is unresponsive to
antihistamines. Chronic pruritus can lead to loss of concentration, sleep deprivation and automutilation or prurigo nodularis due to scratching (1). In most serious cases, suicidal ideations
may occur and the burden of pruritus can become the primary indication for liver transplantation.
Cholestasis-associated pruritus shows a diurnal rhythm with increased intensity in the late evening
and early night. The itch is typically localized at the limbs and soles of the feet and at the forearms
and palms of the hands, but may also be generalized.” Read full article