Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentCopingFAQs
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Coping
FAQs
Cholestatic pruritusis a symptom ofcholestatic liver disease. It is a constant, severe, and sometimes debilitating itching sensation on various parts of the body. Over 80% of people with cholestatic liver disease develop cholestatic pruritus.
This article discusses the symptoms, causes, and treatment options for people with cholestatic pruritus.
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Cholestatic Pruritus Symptoms
Other issues that can arise from cholestatic pruritus include:
Symptoms of Cholestatic Liver DiseaseIn some cases, a person might not be aware they have a liver disease. Aside from itching, other signs of cholestatic liver disease may include:Jaundice(yellowing of the skin or eyes)Urine that is darker than normalPale stoolAbdominal painFatigueNausea
Symptoms of Cholestatic Liver Disease
In some cases, a person might not be aware they have a liver disease. Aside from itching, other signs of cholestatic liver disease may include:Jaundice(yellowing of the skin or eyes)Urine that is darker than normalPale stoolAbdominal painFatigueNausea
In some cases, a person might not be aware they have a liver disease. Aside from itching, other signs of cholestatic liver disease may include:
The main cause of cholestatic pruritus is cholestatic liver disease, which develops when liver cells are unable to secrete bile (digestive fluid) or when there is a bile blockage in thebiliary system.When this happens, bile can build up within the liver, which may further injure or damage the liver.
Various diseases that result in cholestatic liver disease may also cause cholestatic pruritus, including:
Itching develops because various substances, including bile acid,lysophosphatidicacid,endogenous opiates, andprogesteronederivatives, build up within the body and end up in the skin.
However, there may be other, unknownpruritogensinvolved. Pruritogens are substances that cause itching and the urge to scratch after they make their way into the skin.
When Cholestatic Liver Disease Is Left UntreatedIf left untreated, cholestatic itching will worsen. However, more severe consequences may occur, such as chronicliver failure.
When Cholestatic Liver Disease Is Left Untreated
If left untreated, cholestatic itching will worsen. However, more severe consequences may occur, such as chronicliver failure.
Itchy Hands and Feet: Causes and Treatments
Diagnosing cholestatic pruritus is simple if a person has already been diagnosed with cholestatic liver disease. Since the symptom is present in the majority of cases, experiencing the itch is typically enough to make a diagnosis.
If a person has not yet been diagnosed with any type of liver disease, a healthcare provider will note the itching and then take a full health history and review of other symptoms. Then they will develop a treatment plan for both the disease and symptoms like cholestatic pruritus.
How to Test for Cholestatic Liver DiseaseTo diagnose cholestatic liver disease, a medical provider will examine a person for any signs of the condition, such as jaundice or lesions from scratching. Blood work is important to evaluate the severity of the cholestasis and can help differentiating the origin whether from the liver of bile ducts. Imaging of the liver and bile duct will be performed to look for functional issues or structural damage. Other imaging tests may be used to get a better look if results come back inconclusive.
How to Test for Cholestatic Liver Disease
To diagnose cholestatic liver disease, a medical provider will examine a person for any signs of the condition, such as jaundice or lesions from scratching. Blood work is important to evaluate the severity of the cholestasis and can help differentiating the origin whether from the liver of bile ducts. Imaging of the liver and bile duct will be performed to look for functional issues or structural damage. Other imaging tests may be used to get a better look if results come back inconclusive.
Treatment for cholestatic pruritus can be challenging because there are various factors at play.
The first-line treatment for cholestatic pruritus is to treat the underlying condition, if possible. This might include a procedure to remove the obstruction or place a stent to drain the bile, or stop a medication if the cause is drug-induced.
For mild itching, simple skin care using lotions or emollients (moisturizers) may be enough. If these measures are not possible or don’t help,cholestyramine, a type of resin medication that can bind bile acid, might help to remove excess bile from the body.
If cholestyramine doesn’t work, there are other treatment options to consider, such as:
Invasive Treatments for Cholestatic Pruritus
In the event that none of the aforementioned treatment options provide relief to people with cholestatic pruritus, other, more invasive treatments may be explored. They can include:
What Treatment Is Right for You?No single treatment is right for everyone who deals with cholestatic pruritus. To determine which one will work for you, talk to your healthcare provider about your options.
What Treatment Is Right for You?
No single treatment is right for everyone who deals with cholestatic pruritus. To determine which one will work for you, talk to your healthcare provider about your options.
Coping with cholestatic pruritus can be difficult, if not debilitating. In some cases, the itching can be so severe that it substantially affects your quality of life. A person can even develop secondary depression or suicidal ideation as a result.
The best way to cope is to work with your healthcare provider to identify the best treatment option. Since many of the aforementioned treatments work in many people with cholestatic pruritus, it’s likely that one of them will help provide you with relief.
Summary
If you already know that you have cholestatic liver disease and want to relieve the itching, talk to your healthcare provider about treatment options, including various medications and phototherapy. There are both noninvasive and invasive options available to you.
A Word From Verywell
Frequently Asked QuestionsThere are several viable treatment options available for liver disease-induced itching. The first is medication. Medications tend to work for most people with cholestatic itching. However, other, more invasive options can be explored if medications do not work.Roughly 80% to 100% of people with cholestatic liver disease will develop cholestatic itching. In some cases, it is one of the most obvious symptoms of cholestatic liver disease. Jaundice is also often present with cholestatic itching.
Frequently Asked Questions
There are several viable treatment options available for liver disease-induced itching. The first is medication. Medications tend to work for most people with cholestatic itching. However, other, more invasive options can be explored if medications do not work.
Roughly 80% to 100% of people with cholestatic liver disease will develop cholestatic itching. In some cases, it is one of the most obvious symptoms of cholestatic liver disease. Jaundice is also often present with cholestatic itching.
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Patel SP, Vasavda C, Ho B, Meixiong J, Dong X, Kwatra SG.Cholestatic pruritus: Emerging mechanisms and therapeutics.J Am Acad Dermatol.2019;81(6):1371-1378. doi:10.1016/j.jaad.2019.04.035Pollock G, Minuk GY.Diagnostic considerations for cholestatic liver disease.J Gastroenterol Hepatol.2017;32(7):1303-1309. doi:10.1111/jgh.13738Santiago P, Scheinberg AR, Levy C.Cholestatic liver diseases: new targets, new therapies.Therap Adv Gastroenterol.2018;11:1756284818787400. doi:10.1177/1756284818787400Nietsche TR, Dotta G, Barcaui CB, Ferraz MLCG.Cholestatic pruritus: a knowledge update.An Bras Dermatol.2022:S0365-0596(22)00024-1. doi:10.1016/j.abd.2021.06.007Bassari R, Koea JB.Jaundice associated pruritis: a review of pathophysiology and treatment.World J Gastroenterol.2015;21(5):1404-1413. doi:10.3748/wjg.v21.i5.1404
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Patel SP, Vasavda C, Ho B, Meixiong J, Dong X, Kwatra SG.Cholestatic pruritus: Emerging mechanisms and therapeutics.J Am Acad Dermatol.2019;81(6):1371-1378. doi:10.1016/j.jaad.2019.04.035Pollock G, Minuk GY.Diagnostic considerations for cholestatic liver disease.J Gastroenterol Hepatol.2017;32(7):1303-1309. doi:10.1111/jgh.13738Santiago P, Scheinberg AR, Levy C.Cholestatic liver diseases: new targets, new therapies.Therap Adv Gastroenterol.2018;11:1756284818787400. doi:10.1177/1756284818787400Nietsche TR, Dotta G, Barcaui CB, Ferraz MLCG.Cholestatic pruritus: a knowledge update.An Bras Dermatol.2022:S0365-0596(22)00024-1. doi:10.1016/j.abd.2021.06.007Bassari R, Koea JB.Jaundice associated pruritis: a review of pathophysiology and treatment.World J Gastroenterol.2015;21(5):1404-1413. doi:10.3748/wjg.v21.i5.1404
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Patel SP, Vasavda C, Ho B, Meixiong J, Dong X, Kwatra SG.Cholestatic pruritus: Emerging mechanisms and therapeutics.J Am Acad Dermatol.2019;81(6):1371-1378. doi:10.1016/j.jaad.2019.04.035Pollock G, Minuk GY.Diagnostic considerations for cholestatic liver disease.J Gastroenterol Hepatol.2017;32(7):1303-1309. doi:10.1111/jgh.13738Santiago P, Scheinberg AR, Levy C.Cholestatic liver diseases: new targets, new therapies.Therap Adv Gastroenterol.2018;11:1756284818787400. doi:10.1177/1756284818787400Nietsche TR, Dotta G, Barcaui CB, Ferraz MLCG.Cholestatic pruritus: a knowledge update.An Bras Dermatol.2022:S0365-0596(22)00024-1. doi:10.1016/j.abd.2021.06.007Bassari R, Koea JB.Jaundice associated pruritis: a review of pathophysiology and treatment.World J Gastroenterol.2015;21(5):1404-1413. doi:10.3748/wjg.v21.i5.1404
Patel SP, Vasavda C, Ho B, Meixiong J, Dong X, Kwatra SG.Cholestatic pruritus: Emerging mechanisms and therapeutics.J Am Acad Dermatol.2019;81(6):1371-1378. doi:10.1016/j.jaad.2019.04.035
Pollock G, Minuk GY.Diagnostic considerations for cholestatic liver disease.J Gastroenterol Hepatol.2017;32(7):1303-1309. doi:10.1111/jgh.13738
Santiago P, Scheinberg AR, Levy C.Cholestatic liver diseases: new targets, new therapies.Therap Adv Gastroenterol.2018;11:1756284818787400. doi:10.1177/1756284818787400
Nietsche TR, Dotta G, Barcaui CB, Ferraz MLCG.Cholestatic pruritus: a knowledge update.An Bras Dermatol.2022:S0365-0596(22)00024-1. doi:10.1016/j.abd.2021.06.007
Bassari R, Koea JB.Jaundice associated pruritis: a review of pathophysiology and treatment.World J Gastroenterol.2015;21(5):1404-1413. doi:10.3748/wjg.v21.i5.1404
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