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Itching is a sensation that can cause the desire
to scratch.
Patients with chronic liver disease often have concurrent pruritus, which usually begins in the palmoplantar and then becomes generalized
.
Pruritus is mostly intermittent and chronic, worsening
at night.
Severe itching has a negative impact on the patient's life, sleep quality and mental health, so reducing itching and relieving symptoms are clinical issues
that need to be solved.
For reference
, the evaluation, diagnosis, and treatment of pruritus are summarized here.
A summary of the figure: Evaluation and diagnosis
of the cause of pruritus The first step in evaluating the cause of pruritus is to determine whether there is a rash (which may indicate a skin disease).
Other causes to consider after the rash is ruled out include systemic (intrahepatic and extrahepatic), neurological, and psychogenic disorders
.
Local pruritus suggests neurologic or psychogenic disease
.
Figure 1 summarizes the diagnostic approach
to the cause of pruritus.
Fig.
1 Diagnostic methods
of the causes of itching: treatment of itching Drug treatment of
itching includes ursodeoxycholic acid, cholestyramine, rifampicin and μ-opioid receptor antagonists
。 Although ursodeoxycholic acid helps to improve the biochemical indicators of primary biliary cholangitis, it is not effective in relieving pruritus except in patients with intrahepatic cholestasis during pregnancy; Cholestyramine is usually the first-line treatment for liver disease with pruritus; During treatment with rifampicin, a complete blood count and liver function monitoring should be performed; Patients receiving opioid therapy should avoid μ-opioid receptor antagonists
.
In addition, patients with pruritus who do not respond to medical therapy may be considered for plasma exchange, phototherapy, albumin dialysis, or nasobiliary drainage
.
Liver transplantation
may be considered in selected patients with refractory pruritus.
Figure 2 summarizes the general management of
pruritus.
Fig.
2 General management methods
of itching In summary, pruritus is a common symptom
of chronic liver disease.
Cholestyramine is the first-line treatment for itching, and if pharmacotherapy is ineffective, alternative treatments such as phototherapy, plasmapheresis, albumin dialysis can be considered, and liver transplantation
may be considered in patients with severe refractory pruritus.
References:1.
LI Shangdian, XU Chunjun, LIU Yao, et al.
Diagnosis and treatment of itchy skin complicated by patients with chronic liver disease[J].
Journal of Integrated Traditional Chinese and Western Medicine Hepatology, 2021,31(05):462-464 2.
Selim R, Ahn J.
Pruritus in Chronic Liver Disease.
Clin Liver Dis.
https://doi.
org/10.
1016/j.
cld.
2022.
08.
011.
