Cholestatic pruritus varies in location, can appear in all parts of the body, can occur at any stage of the disease, and may diminish with the progression of end-stage liver disease.
1. Cholestatic pruritus may be generalized throughout the body or confined to the extremities (mostly on the palms of the hands and soles of the feet). Cholestatic pruritus is characterized by fluctuations, showing a typical circadian rhythm, with itching peaking in the evening and night. The severity of the itching episodes may diminish over time. Psychological stress, heat and exposure to wool can exacerbate the intensity of itching.
2. In addition to itching, cholestasis may be accompanied by yellow urine, yellowing of the sclera, loss of appetite, and clay-colored stools.
Cholestasis requires timely examination, such as liver function tests, autoimmune antibody tests, and CT, to determine the severity of the condition and to develop a treatment plan.
Several drugs exist for the treatment of cholestatic pruritus, either alone or in combination, including the bile acid sequestering agent cholestyramine, the pregnane X receptor agonist rifampicin, the opioid receptor antagonist naltrexone, and the selective 5-hydroxytryptamine reuptake inhibitor sertraline. Patients are advised to seek medical attention and take medication as prescribed.