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Dermatology · Papulosquamous disorders: cholestatic pruritus
Sample itemA woman with primary biliary cholangitis has severe generalised itching without rash. Which drug is first-line for the pruritus?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Cholestyramine
In cholestatic pruritus, the bile acid sequestrant cholestyramine is first line. Rifampicin, naltrexone and sertraline are successive options. Antihistamines are generally ineffective because histamine is not the main mediator.
Option by option
A. Cetirizine
Antihistamines are poorly effective in cholestatic itch.
B. Prednisolone
Steroids do not relieve cholestatic itch and harm bone.
C. Cholestyramine (correct)
Correct. Cholestyramine is the first-line drug.
D. Methotrexate
Methotrexate is not used for pruritus.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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