CHOLESTATIC PRURITUS - EFFECT OF PHOTOTHERAPY ON PRURITUS AND EXCRETION OF BILE-ACIDS IN URINE

Pruritus associated with hepatic cholestasis may cause significant mor bidity and its correlation to retention of bile acids in skin is incon sistent. Available treatment modalities are only partially effective a nd can have several adverse effects. Phototherapy has recently been re ported to improve cholestatic pruritus, but has not been evaluated pre viously in children, and its mechanism is still unclear. We report the outcome of multiple Daylite phototherapy treatments over two years in a seven-year-old child with chronic hepatic cholestasis that was resi stant to other therapeutic modalities. Bile acid levels in urine were used as markers of effectiveness in parallel with clinical response. N ight phototherapy alone increased the bile acids/creatinine ratio in u rine from 1.54 +/- 0.04 mu mol/mg at baseline to 2.07 +/- 0.29 mu mol/ mg. Continuous phototherapy combined with night diuresis raised the ra tio further to 2.28 +/- 0.55 mu mol/mg. Night diuresis alone had no ef fect. Continuous phototherapy combined with night diuresis raised the bile acids/creatinine ratio by 44% on the first day and by 61% on the second day, but declined to baseline on the third day of treatment. A marked clinical improvement was noted for one week following two days of phototherapy. This schedule has been repeatedly effective in improv ing pruritus for approximately one year and may be due to the ability of phototherapy to enhance excretion of bile acids and other possible pruritogens into urine.