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Itching and PBC

Primary biliary cirrhosis (PBC) is a liver disease of unknown etiology characterized by the presence of anti-mitochondrial antibodies in serum, chronic non-suppurative cholangitis on liver histology and cholestasis Itch is the most common symptom associated with PBC. It has been reported to occur in 25–70% of patients with PBC.  Here is a good article on itch in PBC:   Download Itch PBC  

What worked the best for these patients was antihistamines, cholestyramine and prednisone.  The latter may be associated with unacceptable side-effects with long-term use.

Scabies Treatment

The standard therapy in 2012 for scabies is 5% permethrin cream (Elimite or a generic).  One application is 99% effective.  Two applications, a week apart, are recommended -- so that if someone has scabies there is a 0.01 percent failure rate.  Re-infestation is common unless all contacts are treated.

Five percent permethrin cream is applied over the entire skin from the neck down, especially between the fingers and toes after a warm bath or shower. It is important to reach all areas, except the face, with especially careful attention to the sites of greatest involvement. The medicine should be left on for 12-24 hours and then washed off.  In infants and small children there may be scalp involvement, so that area should be treated as well.  For unknown reasons, lesions above the neck in adults do not occur.

Two applicants of permethrin are all that are necessary. Permethrin is safe to use for children and even infants.  The only contraindication is allergy to chrysanthemums. A second treatment should be performed in one week. It is of the utmost importance that all other household members and close contacts be treated.

An oral medicine, stromectal (Ivermectin), has been approved for use, as well. Stromectol is not approved, at this time, for young children.  In  studies, it appears to be slightly less effective than topical permethrin.

Ordinary laundering or dry cleaning of clothing, bed linens, and blankets is all that is required. Some patients, because of their scratching developed impetigo, and this will have to be treated with appropriate antibiotics. After treatment, it is common for itching to persist for 2-4 weeks.

Re-infestation, unfortunately, can occur. This is suspected in patients who persist in itching for more than two-four weeks after treatment. If evidence of active scabies is found, then re-treatment may be advisable. The patient should be questioned closely about the possible source for re-infestation.  Usually, this turns out to be a close contact who was not treated.

Printable version: Download Scabies Treatment