Cholestatic pruritus

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Cholestatic pruritus - Wikipedia

From Wikipedia, the free encyclopedia

Cholestatic pruritus
Other names	Hepatic pruritus, biliary pruritus
Specialty	Gastroenterology, dermatology, hepatology

Cholestatic pruritus is the sensation of itch due to nearly any liver disease, but the most commonly associated entities are primary biliary cholangitis, primary sclerosing cholangitis, obstructive choledocholithiasis, carcinoma of the bile duct, cholestasis (also see drug-induced pruritus), and chronic hepatitis C viral infection and other forms of viral hepatitis.^[1]

Cause

Cholestasis means "the slowing or stopping of bile flow" which can be caused by any number of diseases of the liver (which produces the bile), the gallbladder (which stores the bile), or biliary tract (also known as the biliary tree, the conduit that allows the bile to leave the liver and gallbladder and enter the small intestine). When this occurs, conjugated bilirubin and the waste products that usually would be cleared in bile reflux back into the bloodstream. This causes a primarily conjugated hyperbilirubinemia and jaundice; the liver conjugates the bile to make it water-soluble and because the bile has already been processed by the liver, when it gets backed up because of a blockage and is refluxed into the blood, the blood will have high levels of conjugated bilirubin. This is in contrast to primarily unconjugated hyperbilirubinemia which is the water-insoluble form that is bound to serum albumin; the liver has not had a chance to conjugate the bilirubin yet and can be caused either because too much unconjugated bilirubin is made (such as in massive hemolysis or ineffective erythropoiesis) or because too little is conjugated (Gilbert's disease or Crigler–Najjar syndrome). Unconjugated hyperbilirubinemia does not typically cause pruritus.

It is thought that bile salts that deposit into the skin are responsible for the pruritus (itching) because the levels of bilirubin in the bloodstream and the severity of the pruritus does not appear to be highly correlated.^[2] Patients that have been administered bile salt chelating agents do report some relief, however, and patients that have complete liver cell failure (and therefore cannot make these products to begin with) do not have pruritus. This suggests that products made by the liver must have some role in pruritus although it is not known exactly which product is responsible.

References

^ Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
^ Graham AJ, Robin AC, Brown G (2008). "Chapter 151: The Skin and Disorders of the Alimentary Tract, the Hepatobiliary System, Kidney, and Cardiopulmonary System". In Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D (eds.). Fitzpatrick's Dermatology in General Medicine (7th ed.). New York: McGraw-Hill Medical. ISBN 978-0-07-146690-5.

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Atopic dermatitis	Prurigo gestationis Sweat allergy
Seborrheic dermatitis	Pityriasis simplex capillitii Cradle cap
Contact dermatitis (allergic, irritant)	plants: Urushiol-induced contact dermatitis African blackwood dermatitis Tulip fingers other: Abietic acid dermatitis Diaper rash Airbag dermatitis Baboon syndrome Contact stomatitis Metal allergy Protein contact dermatitis
Eczema	Autoimmune estrogen dermatitis Autoimmune progesterone dermatitis Breast eczema Ear eczema Eyelid dermatitis Topical steroid withdrawal Hand eczema Dyshidrosis Hyperkeratotic hand dermatitis Autosensitization dermatitis/Id reaction Candidid Dermatophytid Molluscum dermatitis Circumostomy eczema Juvenile plantar dermatosis Nummular eczema Nutritional deficiency eczema Sulzberger–Garbe syndrome Xerotic eczema
Pruritus/Itch/ Prurigo	Lichen simplex chronicus/Prurigo nodularis by location: Pruritus ani Pruritus scroti Pruritus vulvae Scalp pruritus Drug-induced pruritus Hydroxyethyl starch-induced pruritus Senile pruritus Aquagenic pruritus Aquadynia Adult blaschkitis due to liver disease Biliary pruritus Cholestatic pruritus Prion pruritus Prurigo pigmentosa Prurigo simplex Puncta pruritica Uremic pruritus
Other	substances taken internally: Bromoderma Fixed drug reaction Nummular dermatitis Pityriasis alba Papuloerythroderma of Ofuji

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Pruritic skin conditions

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