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Pruritus secondary to primary biliary cholangitis: a review of the pathophysiology and management with phototherapy

Lookup NU author(s): Dr Amaani HussainORCiD, Robert Samuel, Dr Vinod Hegade, Professor David Jones, Professor Nick ReynoldsORCiD


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© 2019 British Association of DermatologistsBackground: Primary biliary cholangitis (PBC) is an autoimmune hepatobiliary disorder characterized by destruction of liver bile ducts leading to intrahepatic cholestasis. It causes intractable pruritus for which ultraviolet (UV)B phototherapy is an experimental treatment when alternative therapies fail. The pathophysiology of cholestatic itch and the mechanism of action of narrowband UVB in this condition remains poorly understood. Objectives: To summarize the current literature and propose testable hypotheses for the mechanism of action of phototherapy in attenuating itch. Methods: A focused PubMed search for articles relating to the pathogenesis of itch in cholestatic disease was performed. A total of 3855 articles were screened and 50 were found suitable for literature review. Evidence from this literature review was combined with author expertise in the area. Results: Formulated hypotheses focus on the role of bile salts, autotaxin and specific receptors including G-protein-coupled bile acid receptor, Gpbar1 (also known as TGR5) and the nuclear transcription factor farnesoid X receptor. Conclusions: Several testable mechanisms through which phototherapy may exert its effects are discussed in this review. The next steps are to carry out an objective assessment of the efficacy of phototherapy in cholestatic pruritus, gain further knowledge on the underlying pathways, and subsequently trial its use against current licensed therapies. Such studies could lead to increased mechanistic understanding, identification of novel therapeutic targets and the potential to refine phototherapy protocols, leading to improved control of itch and quality of life in patients with PBC.

Publication metadata

Author(s): Hussain AB, Samuel R, Hegade VS, Jones DE, Reynolds NJ

Publication type: Review

Publication status: Published

Journal: British Journal of Dermatology

Year: 2019

Volume: 181

Issue: 6

Pages: 1138-1145

Print publication date: 03/12/2019

Online publication date: 28/03/2019

Acceptance date: 28/02/2019

ISSN (print): 0007-0963

ISSN (electronic): 1365-2133

Publisher: Blackwell Publishing Ltd


DOI: 10.1111/bjd.17933

PubMed id: 30920648