Practical Approach for the Diagnosis and Treatment of Chronic Pruritus

Abstract

Chronic itch is a common condition that affects the quality of life of many patients and can often be difficult to treat. When managing a patient with itch, the first step requires identification of the underlying cause, which may be dermatologic or nondermatologic in nature. The process begins with a thorough history and physical examination, which may or may not be followed by laboratory tests and imaging. The appropriate treatment for each patient should be considered based on the diagnosis, severity of itch, and individual patient preference. Treatment options range from topical treatments, which may be indicated for more mild types of itch, to systemic treatments, which may be indicated for itch that is more ubiquitous and debilitating in nature. Within the last decade, developments in our understanding of itch pathophysiology has led to new treatment options on the horizon that consist of more targeted medications, including monoclonal antibodies and opioid modulators.