Pruritus in Chronic Liver Disease

Pruritus can be associated with chronic liver disease , particularly cholestatic liver disease. Although the pathophysiology is uncertain, there are a few proposed mechanisms and much is still being discovered. Workup involves an assessment to rule out a dermatologic , neurologic, psychogenic, or other underlying systemic disorder . First-line therapy is cholestyramine , which is generally well tolerated and effective. In those who fail cholestyramine, alternative drugs including rifampicin and μ-opioid receptor antagonists can be considered. If medical therapy is ineffective and pruritus is significant, alternative experimental therapies such as albumin dialysis , photopheresis , plasmapheresis , and biliary diversion can be considered.