14 Progesterone metabolites.  Steroid sulfates and disulfates are predominantly progesterone metabolites that are increased in patients with ICP.34 Intrahepatic cholestasis of pregnancy is characterized by pruritus and elevated levels of bile acids, at serum bile acids ≥ 40 µm the incidence

of ICP is 1.5% and increased fetal complications occur.35 Administration of ursodeoxycholic acid (UDCA) to these patients not only lowers the levels of bile acids but also decreases the levels of steroid disulfates and improves pruritus, which is thought to be due to increased hepatobiliary secretion of progesterone metabolites, this is suggested by the decreased urinary excretion of disulfated progesterone metabolites.36,37 These interesting findings make steroids an attractive candidate in the modulation of cholestatic pruritus. In summary, several

potential pathways are established in mediating the pruritic response, although Selleckchem Daporinad it may be thought that this acts only in confusing rather than clarifying the pathophysiology of pruritus. However, the presence of many pathways also opens the door for various treatment modalities as different receptors may be targeted by medications, either selectively or collectively. Autotaxin may increase pruritus by increasing LPA in serum. The evaluation www.selleckchem.com/products/Staurosporine.html of pruritus depends on understanding the implications of this debilitating symptom on the patient’s quality of life. Several aspects may be included to assess quality of life including Teicoplanin symptoms, functional limitations and emotional well being. There are several innovative methods that have been developed to evaluate the severity of pruritus. One of the most commonly used methods is the visual analog scale (VAS). The visual analog scale was first described in 1973 by Patrick et al. and is based on decoding a subjective symptom such as pruritus into a point on a line, with a starting point of no itching and an endpoint indicating the worst itching possible, the patient will

then mark their level of pruritus on the scale to indicate the severity of symptoms.38 Two other scales, the Eppendorf Itch Questionnaire and the Questionnaire for the Development of Pruritus, assess the patient’s subjective experience with pruritus. This is done through the following: the Eppendorf Itch Questionnaire is a modification of the McGill pain questionnaire and uses a detailed list of sensory and emotional categories. These categories aim to identify the severity of symptoms and the resultant debilitating effects. Similarly, the Questionnaire for the Development of Pruritus gathers information in regard to the effect of pruritus on the patient’s quality of life. Although they both address pruritus adeptly; however, they are time consuming.39,40 Recently, the 5-D itch scale was developed by identifying 234 patients of whom 63 suffered from pruritus related to liver disease.