What is pruritus?

Pruritus is the medical term for severe itching. Cholestatic pruritus is a term used to describe itching caused by liver disease. Itching can occur when there is poor bile flow within and from the liver (cholestasis).

There are some liver diseases in which itching can be particularly troublesome such as progressive familial intrahepatic cholestasis (PFIC) and Alagille syndrome. Poor bile flow leads to high levels of bile acids in the blood stream. It is thought that these bile acids lead to itching.

Jaundice is not always present in people with pruritus. Itching is usually felt all over the body but most severely affects the palms of the hands, the soles of the feet and the upper part of the body (the trunk). The itching may come and go in phases or in different seasons.

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How can pruritus affect a child or young person?

The level of the itch can vary from person to person. It can range from being mild and more of an annoyance to being very disruptive and interfering with sleep and daily life. In rare cases pruritus can become so severe that a liver transplant is considered in order to improve the quality of a child’s life.

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What treatment is available for pruritus?

A number of medicines are available that can be used to relieve pruritus. Some people may take more than one medicine at a time and it can take some time to find the best combination.

Sometimes medicines can work well to stop the itch; however, in other cases they may work for a short time but then stop working and need to be altered. It may be difficult to find a combination that works for a particular person.

There are operations that may be considered such as biliary diversion but success is very variable.

Sometimes itching may have more than one cause, such as liver disease and eczema, so more than one treatment approach may be needed.

Some of the most common medicines used are:

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Tips for dealing with pruritus

Itching can cause distress and discomfort. When children are very young they won’t be able to tell you what the problem is.

Here are some hints and tips from other parents to help to deal with pruritus:

• Keep your child’s nails short.
• Encurage rubbing rather than scratching.
• Use moisturisers and ointments to try and soothe your child’s skin. Some nparents suggest cold moisturiser from the fridge can be especially soothing and others suggest massaging oils into the skin.
• Keep your house cool as the heat can make children itchier.
• A cool bath can help. Keep the water cooler than normal and add baby oil to the water.
• In very young children try and use clothes that cover the whole body e.g. baby grows at night and dungarees in the day to prevent the child from scratching their skin.
• Use a wool or cotton underblanket to make the mattress feel softer and use cotton bedding.
• Dress children in loose cotton clothes and avoid wool, acrylics and polyesters.
• Sew socks onto pyjamas to prevent scratching at night.
• Scratch mitts and scratch sleeves can be used to stop children scratching their skin.
• Older children may find that watching TV or talking to friends online are a good distraction.
• Distract children with a favourite toy, by moving to another room, or finding other people to play with (brothers and sisters can help here).
• Speak to your child’s school regarding exams and the potential for extra thinking time as itching can be a real distraction.

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Useful words

Cholestasis – a condition where the flow of bile is reduced

Pruritus – a medical word for itching