Treatment of Pruritus (Skin Itching) in Primary Sclerosing Cholangitis Without Dominant Biliary Stricture
Pruritus is a common and potentially severe complication of Primary sclerosing cholangitis. When no dominant or relevant biliary stricture or obstruction is present, a structured therapeutic pathway guides management of this symptom.
Clinical scenario
This protocol addresses patients with Primary sclerosing cholangitis who present with pruritus (skin itching) in the absence of a dominant or relevant biliary stricture or biliary obstruction. Pruritus affects a substantial proportion of PSC patients and can be severe and disabling.
Therapeutic approach
For patients in this scenario, the full protocol defines a stepwise therapeutic pathway. When earlier lines of therapy have not provided adequate relief, selected pharmacological agents and procedural interventions may be considered as part of the defined next step.
References
DOI: 10.1002/hep.32771
- Many patients with PSC (30%–60%) suffer from pruritus, or itch, which can be severe and disabling.
- In the absence of a relevant stricture, a stepwise therapeutic approach should be followed starting with heat avoidance, emollients, and/or antihistamines, followed if necessary by first-line (cholestyramine), second-line (sertraline, rifampin, and/or naltrexone), and third-line (phenobarbital, plasmapheresis, and/or phototherapy) therapy, with LT considered for continued refractory symptoms.
- For patients unresponsive to these regimens, phenobarbital (60–100 mg/day), phototherapy, and plasmapheresis have been reported in small case series as being effective; and in rare cases, LT may be indicated.