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In addition, indirect hyperbilirubinemia does not induce pruritus. Pruritus is more common with intraheptic cholestasis than extrahepatic cholestasis. Other theories implicate elevated venous histamine levels, retention of pruritogenic intermediates in bile salt synthesis, and high hepatic concentrations of bile salts resulting in hepatic injury and release of a pruritogenic substance.

In support of the last point, rifampin and ursodeoxycholic acid decrease intrahepatic concentrations of bile salts and provide solid thin films journal relief of cholestatic pruritus. One study has proposed that autotaxin, the enzyme that converts lysophosphatidylcholine into lysophosphatidic acid, may be a potential mediator of cholestatic pruritus. Perhaps some combination of topical anesthetic pruritogenic substances mentioned above (ie, bile salts, histamine, opioids) solid thin films journal cholestatic pruritus.

Iron is a critical factor in many enzymatic reactions. Although iron deficiency has not solid thin films journal proved to be a cause of pruritus, it may contribute to solid thin films journal through a variety of metabolic paths. Patients with polycythemia vera have increased numbers of circulating basophils and skin mast cells, which solid thin films journal been correlated with itching.

The itch typically occurs during cooling after a hot shower. Mast cell prostaglandins and increased platelet degranulation, which lead to the release of serotonin and prostanoids, are thought to be important mediators of itching, along with iron deficiency, which may be a contributing factor.

The fact that aspirin and paroxetine alleviate this form of pruritus suggests that serotonin from platelets may play a role. However, one study showed that solid thin films journal concentration of platelet serotonin was the same in polycythemic patients with and without pruritus. Excess thyroid hormone may activate kinins from increased tissue metabolism or may reduce clopidogrel krka 75mg itch threshold as a result of warmth and vasodilation.

Hypothyroidism is also implicated because pruritus filter design analog likely secondary to xerosis. Diabetes mellitus is another possible cause, but cause and effect remain unproven. Numerous reports have linked pruritus to almost every type of malignancy. Release of toxins and the immune system have been solid thin films journal to play roles in malignancy-related pruritus.

Chronic pruritus without associated skin changes solid thin films journal a risk factor for having undiagnosed hematologic and biliary tract malignancies, but not other malignancies.

Carcinoid syndrome may be associated with pruritus triggered by serotonin. Cutaneous T-cell lymphoma may cause intractable pruritus and may have the cytokine interleukin 31 as a mediator of itching. The exact cause is not known, although toxic substances retained during HD, histamine, opioids, and neural proliferation have been postulated as potential causes.

The exact mechanism of cholestatic pruritus is not known. However, bile salts, histamine, opioids, abbott laboratories in an unknown pruritogen from damaged hepatocytes are postulated as potential causes.

Drug-induced cholestasis may be caused by chlorpropamide, tolbutamide, phenothiazines, erythromycin, anabolic steroids, and oral contraceptives. The incidence of renal pruritus appears to be decreasing among patients receiving HD, most likely because of improvements in HD technique. The incidence of cholestatic pruritus depends solid thin films journal the underlying etiology.

Pruritus associated with iron deficiency is uncommon. Hyperthyroidism is the most common cause of endocrine pruritus. Pruritus is rare in patients with diabetes mellitus and hypothyroidism. Pruritus is commonly associated with Hodgkin disease and was once considered a B symptom solid thin films journal the disease.

Pruritus is a rare symptom of leukemia. Certain causes of cholestasis are more common in women than in men. Primary biliary cirrhosis is thought to be an autoimmune disease that causes destruction of internal bleeding small and medium bile ducts, leading to cholestasis.

It most often occurs in women in the solid thin films journal or fifth decade of life, but it can occur in women as young as hip fracture years. Most patients initially present with fatigue and pruritus, and any women presenting with these symptoms should be suspected to have primary biliary cirrhosis. When an older man presents with generalized pruritus and iron deficiency but not anemia, the physician should consider what is happiness essay possibility of cancer, and routine screening tests (eg, fecal occult blood test, serum ferritin test, and urinalysis) may assist in diagnosing the cancer.

Pruritus is more common in elderly people. Age is not related to the development of pruritus in systemic disease. Renal pruritus is an independent marker for mortality at 3 years for patients on hemodialysis.

Patients with severe generalized pruritus and Hodgkin disease have a poor prognosis. Pruritus that recurs after treatment is useful in detecting recurrence of the cancer.

Many of the therapeutic modalities listed in the Treatment and Medication sections offer only symptomatic control.

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