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Pruritus

Pruritus can occur when there is poor bile flow, known as cholestasis. It is thought that this is due to the excessive amounts of harmful bile acids circulating in the blood stream.

For some children with liver disease itching can become a significant problem, although the degree can vary greatly from patient to patient. It us usually felt all over the body, but most severely affects the palms, soles of the feet, extremities and upper part of the body.

How is pruritus treated?

Several medications are used in order to try and relieve the itching; a combination may be used and it may take time to find the best combination for your child.

These are the most commonly used medicines:

Cholestyramine (Questran)

This combines with the bile acids in the small intestine and reduces reabsorption. Some side effects may be experienced, such as abdominal distension and constipation. The medicine may also bind with the fat soluble vitamins A, D, E and K, further decreasing their absorption.

Phenobarbitone

This medicine is known to stimulate some aspects of liver function, which helps the liver excrete the substances thought to induce itching. It may have a sedative effect and is usually given at night.

Rifampicin (Rimactane)

An antibiotic commonly used to treat tuberculosis, Rifampicin is used in patients with cholestatic liver disease and gives complete relief from pruritus in some patients and significantly reduces it in others.

Sedatives

Sedatives such as Vallergan may be prescribed if itching is severely affecting sleep.

Ursodeoxycholic acid (URSO)

This is a substance which naturally occurs in bile, and works by increasing the proportion of watery bile salts, helping the bile to flow more easily.

What can be done to help children with pruritus?

Itching can cause serious discomfort and with very young children they may not be able to tell you what is wrong. It can become more intense in the evening, resulting in a baby waking several times during the night.

Some practical advice tips from parents:

  • Try to distract your child as soon as possible
  • A cool bath may help and adding baby oil to the water will help to moisturise the skin, which can be much dryer than usual.
  • Loose cotton clothes are best – avoid wool and synthetic materials such as polyester.
  • Try and use clothes which cover the body, such as a baby grow at night and dungaree type trousers during the day. For babies, mittens can help to keep scratches to the arms, legs and head to a minimum
  • Skin cream massaged after the bath can give temporary relief
  • All-cotton bedding is recommended
  • Try and keep a child cool, as the hotter they get, the more they itch
  • Evening primrose oil rubbed into the skin can help
  • For older children, sew a sock onto the openings for feet and hands on night clothes to keep scratches to a minimum.

 

Want to know more?

Download CLDF’s leaflet on pruritus.

Read stories by those affected by pruritus including the itch that was only cured by a liver transplant.

The information on this site is for guidance only. It is not a substitute for professional medical care by a qualified doctor or other health care professional. ALWAYS check with your medical team if you have any concerns about your condition or treatment. CLDF is not responsible or liable, directly or indirectly, for any form of damages resulting from the use (or misuse) of information contained in or implied by the information on this site.