Itch (also called pruritus) is one of the most commonly reported symptoms by people with PSC. Itch can seriously impact on your quality of life.
Symptom management: itch
The cause of itch in PSC is not clear and several mechanisms have been proposed, including increased levels of bile salts in the blood 120,121. Sudden onset of itch is cause for concern and you should contact your PSC doctor as soon as possible to let them know. A range of medicines are used to control itch, however in certain cases this may be a very difficult-to-control symptom.
Assessment and management
Your doctor should ask you about itch and consider medicines outlined in the EASL guidelines. If a medicine doesn’t resolve your itch, you should let your doctor know, so that a medicine that works in a different way can be considered. In the UK, cholestyramine (Questran) is considered first, with rifampicin and naltrexone as second line therapies. The consistency of cholestyramine makes it somewhat unpleasant to take, although there are different ways you can take it and it is also occasionally available in tablet form. You can also disguise the texture by adding it to food.
There have been concerns about the use of rifampicin in liver disease patients in the past. A 2018 study looked at 105 adults with PSC and PBC and found that 95%, including those with jaundice and advanced liver disease took rifampicin safely. The researchers conclude, ‘In the absence of alternative safe, licensed and equally effective agents, clinicians may consider, the use of rifampicin in cholestatic pruritus’ 122. In some cases, sertraline is also attempted.
At each review appointment or earlier if itch is not resolved.
EASL Cholestatic Guidelines Section 11.1 4.