TY - JOUR
T1 - Cholestatic pruritus
T2 - Emerging mechanisms and therapeutics
AU - Patel, Sagar P.
AU - Vasavda, Chirag
AU - Ho, Byron
AU - Meixiong, James
AU - Dong, Xinzhong
AU - Kwatra, Shawn G.
N1 - Publisher Copyright:
© 2019 American Academy of Dermatology, Inc.
PY - 2019/12
Y1 - 2019/12
N2 - Patients suffering from cholestasis often report experiencing a debilitating, unrelenting itch. In contrast to conditions, such as urticaria, in which histamine primarily drives itch (pruritus), cholestatic pruritus is multifactorial and more difficult to treat. Existing therapies are not always effective and have undesirable adverse effect profiles. Here, we conducted a systematic literature review to evaluate conventional treatment strategy, current pathophysiologic understanding, and the role of new therapies in the context of cholestatic pruritus. We discuss novel findings implicating bile acids, lysophosphatidic acid, and bilirubin as potential important mediators of cholestatic itch. New therapies that aim to remove or modulate pruritogens have been supported in observational cohort studies and randomized controlled trials. Although these new therapies show promise, further research is needed to confirm the pathophysiology of cholestatic pruritus so that targeted therapy can be developed.
AB - Patients suffering from cholestasis often report experiencing a debilitating, unrelenting itch. In contrast to conditions, such as urticaria, in which histamine primarily drives itch (pruritus), cholestatic pruritus is multifactorial and more difficult to treat. Existing therapies are not always effective and have undesirable adverse effect profiles. Here, we conducted a systematic literature review to evaluate conventional treatment strategy, current pathophysiologic understanding, and the role of new therapies in the context of cholestatic pruritus. We discuss novel findings implicating bile acids, lysophosphatidic acid, and bilirubin as potential important mediators of cholestatic itch. New therapies that aim to remove or modulate pruritogens have been supported in observational cohort studies and randomized controlled trials. Although these new therapies show promise, further research is needed to confirm the pathophysiology of cholestatic pruritus so that targeted therapy can be developed.
KW - PBC
KW - PSC
KW - cholestasis
KW - itch
KW - primary biliary cholangitis
KW - primary sclerosing cholangitis
KW - pruritus
UR - http://www.scopus.com/inward/record.url?scp=85071397838&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071397838&partnerID=8YFLogxK
U2 - 10.1016/j.jaad.2019.04.035
DO - 10.1016/j.jaad.2019.04.035
M3 - Review article
C2 - 31009666
AN - SCOPUS:85071397838
SN - 0190-9622
VL - 81
SP - 1371
EP - 1378
JO - Journal of the American Academy of Dermatology
JF - Journal of the American Academy of Dermatology
IS - 6
ER -