Pruritus Secondary to Primary Biliary Cholangitis

A Review of the Pathophysiology and Management With Phototherapy

A.B. Hussain; R. Samuel; V.S. Hegade; D.E. Jones; N.J. Reynolds


The British Journal of Dermatology. 2019;181(6):1138-1145. 

In This Article

Search Strategy

In April 2018 we searched PubMed for articles relating to the pathogenesis of itch in cholestatic disease. Our search terms included 'pruritus', 'cholestasis', 'itch', 'UVB', 'phototherapy' individually and in combination. We screened the titles and abstracts of 3855 articles generated through our search terms. Our criteria for inclusion were literature published in English discussing the pathophysiology or effect of phototherapy on cholestatic pruritus, published within the last 5 years. Both animal and human studies and case reports, including single case reports, were included. Using this method, a total of 50 articles were found to be suitable for review. When these articles referenced other relevant articles, which were not identified through our original search terms, these articles were also reviewed. Certain areas of research have been omitted from this review, including the role of substance P, serotonin and endogenous opioids. These areas have been covered in several previous reviews and do not appear relevant to the pathophysiology of cholestatic itch or the potential mechanism of action of phototherapy.[23,28,29]

Combining evidence from the literature alongside our own expertise in the area, we have formulated several theories that discuss the pathophysiology of cholestatic itch and mechanisms of attenuation by phototherapy, potentially aiding the recognition of new therapeutic targets. Here, we focus on the role of bile salts, ATX and LPA, and receptor expression.