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2 results

  • Case 22 - A 40-Year-Old at 34 Weeks’Gestation with Worsening Itching

  • from Section 3 - Antepartum (Late Pregnancy)
  • Edited by Peter F. Schnatz, The Reading Hospital, Pennsylvania, D. Yvette LaCoursiere, University of California, San Diego, Christopher M. Morosky, University of Connecticut School of Medicine, Jonathan Schaffir, The Ohio State University College of Medicine, Vanessa Torbenson, Mayo Clinic Alix School of Medicine, David Chelmow, Virginia Commonwealth School of Medicine
  • Book:
    Pregnancy Complications
    Published online:
    08 April 2025
    Print publication:
    01 May 2025, pp 69-70

  • Summary

    Intrahepatic cholestasis of pregnancy is a transient disorder that typically occurs during the second and third trimesters. It is characterized by pruritis, most intensely along palms and soles of feet, and elevated serum bile acids. While it does not pose any maternal risks outside of discomfort, it does increase fetal risks of stillbirth, preterm labor (spontaneous and iatrogenic), and meconium-stained fluid. Once the diagnosis is made, treatment with ursodeoxycholic acid should be initiated. This medication works to provide symptomatic relief of pruritis and improve laboratory abnormalities. Antenatal fetal testing should begin at diagnosis or at 32 weeks. Delivery is indicated at 36 0/7–39 0/7 weeks if bile acids are 10–100 µmol/L and at 36 0/7 weeks if bile acids are >100 µmol/L. If delivery is performed prior to 37 0/7 weeks’ gestation, corticosteroids should be administered.

  • New treatment strategy and assessment questionnaire for external auditory canal pruritis: topical pimecrolimus therapy and Modified Itch Severity Scale

  • B Acar, H Karabulut, Y Sahin, M A Babademez, A S Karadag, R M Karasen
  • Journal:
    The Journal of Laryngology & Otology / Volume 124 / Issue 2 / February 2010
    Published online by Cambridge University Press:
    19 November 2009, pp. 147-151
    Print publication:
    February 2010
  • Objective:

    We aimed to compare the efficacy of topical pimecrolimus versus hydrocortisone in treating external auditory canal pruritis, using the Modified Itch Severity Scale as an assessment tool.

    Methods:

    We included in the study 40 patients with isolated itching of the external auditory canal who had not received any benefit from previous topical and systemic treatments. Topical 1 per cent pimecrolimus or topical hydrocortisone was applied to each patient's external auditory canal for three months. A Modified Itch Severity Scale was developed and used to assess treatment response.

    Results:

    Compared with itching scores on initial assessment, the scores of patients receiving topical pimecrolimus had decreased by 52.3 per cent by the third week of treatment and by 77.6 per cent by the third month, whereas the scores of patients receiving topical hydrocortisone had decreased by 34.4 per cent by the third week and by 64.2 per cent by the third month.

    Conclusions:

    Topical pimecrolimus appears to be as effective as topical hydrocortisone in relieving external auditory canal pruritis. We used a novel scoring system, the Modified Itch Severity Scale, to evaluate external auditory canal pruritus; this is the first self-reporting questionnaire for the quantification of external auditory canal pruritus severity. Further studies are needed to validate this scoring system.