Pruritus - Itching in PBC

Itching in PBC is unlike any other type of itching, and the exact cause is still unknown. The PBC itching is thought to be due to the retained bile salts deposited in the skin. The bile salts have an irritant effect on the skin which can be mild to severe.

Almost all those diagnosed with PBC will eventually experience the PBC itching. The most common itching spots are the ears, palms of hands and soles of the feet.

Some experience only occasional itching, while others the itching is so severe that it affects their daily life. Usually the most severe itching takes place in later stages, and in some transplantation is the only cure. It has also been observed that as the liver fails, the itching improves.

Comments and helpful tips from some of our PBCers who experience the PBC itching.

Many with PBC find the itching increases:

• At night sleeping or resting.
• In the sun
• Hot humid temperatures
• After eating fatty foods.
• After eating salty foods.
• After exercise and perspiring.
• After taking hot showers or baths.

Hints to help ease the itching:

• PBC tends to dry out our skin, which increases the itching.....Moisturize, moisturize, moisturize. There are numerous products on the market, but many of us have found Udder cream (used on cow udders) to be very helpful. A huge container is very inexpensive.
• Avoid tight and rough texture clothing. Soft, loose fitting clothing will help.
• Cool to warm oatmeal baths seems to relieve itching even if for a short period.
• During hot weather stay in air conditioned areas, if possible.
• Drink plenty of water.
• Avoid fatty and salty foods.
• Soles of feet are itching, some have suggested soaking feet in cool white distilled vinegar and water. I tried this and found it no help.
• Avoid changing laundry detergents & softeners I have found it very helpful to wash some of my clothes in the same hair shampoo I use, and rinse them twice. Yes, it does get your clothes clean and they don't fade as fast.
• Open skin cuts should be kept clean and antibiotic cream used to avoid infection.

Medications used to help itching:

• Actigall & Urso: Some have found increasing their daily dosage for a short period can help the itching.  Be sure you check with your doctor before increasing your dosage.
• Questran (Cholestyramine) It has been found to greatly reduce itching. It may affect the absorption of other medications, so it is very important not to take with other meds. Recommendation is at least 2 hours before or after. Questran can be purchased in individual packets, but purchasing the canister and measuring your own can be as much as half the cost in some areas. Colestipol another similar medication.
• Rifampin, an antibiotic has shown to help. It can be toxic to the liver, so use should be monitored.
• Acupuncture
• Ultraviolet light treatments
• Benadryl (Antihistamines) can be helpful, but can increase the dry mouth symptom of PBC and Sjogrens.
• Some other medications used, but from what I've read only in very severe cases. Phenobarbital and Codeine.

Some treatments being tested for pruritus: Methotrexate, plasmaphersis, charcoal hemoperfusion, and S-adenosyl-methionie (SAMe).

Doctors Panel Answers the PBCers Questions On Itching

HealthCentral - General Encyclopedia - Itching

Alternative names: pruritus

Definition: A peculiar tingling or uneasy irritation of the skin which causes a desire to scratch the affected part.

Considerations:

Itching can be all over (generalized) or only in a particular location (localized).

There are many causes of itching ranging from the simple to the complex. Some groupings would include:

• Localized itching

  • skin irritation from insect bites and stings

  • Localized or generalized

  • chemical irritation such as from poison ivy or stinging nettle

  • environmental causes (drying, sunburn)

  • hives (localized to general)

  • parasites (body lice, head lice, pubic lice)

• Generalized

  • infectious diseases (chicken pox)

  • allergic reactions

  • liver disease with jaundice

  • medication reactions

  • Not every rash itches, but if it does, try not to scratch it.

Common causes:

• insect bites

• dry skin

• contact dermatitis (poison ivy or poison oak)

• contact irritants (such as soaps, chemicals, or wool)

• atopic dermatitis

• rashes (may or may not itch)

• childhood infections (such as chicken pox or measles)

• aging skin

• allergy caused by food or drugs (antibiotics)

• superficial skin infections such as folliculitis and impetigo

• pregnancy

• hepatitis

• iron deficiency anemia

• parasites such as pinworm

• pityriasis rosea

• psoriasis

• seborrheic dermatitis

• skin infection

• urticaria

• drugs such as antibiotics (penicillin, sulfonamides), gold, griseofulvin,

• isoniazid, opiates, phenothiazines, or vitamin A

Note: There are other causes of itching. This list is not all inclusive, and the causes are not presented in order of likelihood. The causes of this symptom can include unlikely diseases and medications. Furthermore, the causes may vary based on age and gender of the affected person, as well as on the specific characteristics of the symptom such as location, quality, time course, aggravating factors, relieving factors, and associated complaints.

Use the Symptom Analysis option to explore the possible explanations for itching, occurring alone or in combination with other problems.

Home care:

For persistent or severe itching, have the dermatologist (a specialist in skin disorders) make the precise diagnosis and prescribe specific treatment.

In the meantime, there are some steps you can take to help deal with the itch:

• Avoid scratching or rubbing the itchy areas. Keep fingernails short to avoid

• skin damage from any unconscious scratching. Family members or friends may

• help call attention to subconscious scratching.

• Wear cool, light, loose bedclothes. Avoid wearing rough clothing,

• particularly wool, over an itchy area.

• Take lukewarm baths using little soap and rinsing thoroughly. Try a

• skin-soothing oatmeal or cornstarch bath.

• Apply a soothing lotion after bathing to soften and cool the skin.

• Apply cold compresses to an itchy area.

• Use ointments on the skin (except for children under 2 years of age) and take

• prescribed medications as directed.

• Avoid prolonged exposure to excessive heat and humidity.

• Take up an enjoyable hobby that distracts from the itching during the day and

• makes you tired enough to sleep at night.

• Try over-the-counter antihistamines such as diphenhydramine (Benadryl). If

• there is a sore, such as with chicken pox, consult your health care provider

• before using diphenhydramine on the skin (such as diphenhydramine in

• Caladryl).

Call your health care provider if:

• itching is associated with other unexplained symptoms.

• itching is severe, prolonged, or cannot be easily explained.

Notes: Most itching does not require medical evaluation. Attempts should be made to rule out the obvious causes of itching. It is sometimes easy for a parent to discern the cause of a child's itching. Usually a simple visual examination will demonstrate the presence of bites, stings, rashes, dry skin or irritation. Often the cause of itching is fairly obvious such as a mosquito bite.

Recurrent itching without obvious cause, total body itching, and recurrent hives are all indications that the itching should be evaluated as soon as possible. It may be a symptom of an underlying disease or condition.

Many with PBC have mentioned this particular itching problem.

What is pruritus ani?

This refers to itching around the anal area. It is often most troublesome at night or following a bowel movement.

What causes pruritus ani?

• Excessive cleaning or wiping of the anal area is frequently the culprit.

• Excessive sweating in the area around the anus is another cause.

• Certain beverages, including alcohol, citrus drinks, and caffeine-containing drinks may aggravate the problem

• highly-spiced foods, chocolate, nuts and popcorn may be irritating as well.

• Rarely, infections and skin conditions can produce pruritus ani.

• Poor hygiene is usually not a cause. Unfortunately, when the problem develops, individuals often compound the problem by

  • excessively washing and cleaning the anal area. This leads to a cycle of increased irritation.

How is pruritus ani treated?

• avoid irritating soaps (often those containing perfumes)

• gently blot the area clean with a moist wash cloth

• never excessively rub or scratch the area

• eliminate irritant foods and beverages (coffee, alcohol, spicy foods)

• keep the area dry with powder (avoid perfumed or deodorant powders)

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