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Cholestasis therapy frequently resolves pruritus in pregnancy. (Antihistamines Often Ineffective).

PARIS -- Pruritus that develops during pregnancy is often related to transient and recurrent cholestasis, treatment of which resolves the itch in most patients, Dr. Nuha T. Kusaimi reported at the 20th World Congress of Dermatology.

About 20% of pregnant women experienced itch of varying intensity during pregnancy Systemic antihistamines and conventional local therapies are frequently ineffective, said Dr. Kusaimi of the University of Mosul (Iraq).

In a study aimed at characterizing pruritus caused by liver dysfunction during pregnancy Dr. Kusaimi studied 42 pregnant women with itching who presented at her private practice clinic over a 10-month period. Among them, 26 experienced itching specific to their pregnancy (group 1); 16 complained of symptoms from a preexisting condition or a coincidentally acquired skin disease unrelated to pregnancy (group 2). Twenty healthy pregnant women without pruritus served as controls.

Along with a detailed history and clinical exam, all patients had urinalysis and lab tests to measure hemoglobin, white blood cell count, serum alkaline phosphate, liver function, serum bilirubin, and cholesterol.

Patients with itching due to pregnancy were more apt to complain of severe symptoms (100%) than those with itching from other causes (81%).

Half of patients with pregnancy-related pruritus began itching in the third trimester, 35.7% of patients began itching in the second trimester, and 14.3% began to experience symptoms in the first trimester.

Most patients with pregnancy-related pruritus developed prurigo gestationis (42.3%), followed by pruritic urticarial papules and plaques of pregnancy (26.9%), and papular dermatitis of pregnancy (23.1%). Lesions appeared most frequently on the upper and lower extremities, the abdomen, and the back.

The mean serum cholesterol level among women with pregnancy-related pruritus was 236.6 mg/dL, compared with a mean of 196.9 mg/dL among patients in the group with itching unrelated to pregnancy and 188.3 mg/dL for controls.

When the serum cholesterol was higher than normal (above 200 mg/dL), cholestyramine powder, 4g taken daily in two doses for 6-10 days, was very effective in entirely resolving the pruritus and improving the lesions among most of the patients (80%) with pregnancy-related pruritus.

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Author:DeMott, Kathryn
Publication:Family Practice News
Date:Nov 1, 2002
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