Revised: July 12, 2012
Accepted: July 26, 2012
Published online: August 2, 2012
Itch is a common problem and it can be debilitating. In the approach to managing chronic pruritic diseases, the key would be to identify the underlying cause and to adopt treatment specific to the condition. Unfortunately, in many cases, the cause/s can be occult. A careful examination for an underlying primary dermatosis is required, and repeated examinations at intervals may be needed. In generalized pruritus without a primary dermatosis, investigations to exclude a systemic disease are usually necessary. If the cause is still not determined, a trial of therapy may be very useful. The next step in the approach to chronic pruritus would be to use anti-pruritic agents specific to the type of pruritic disease. As we understand more about the patho-physiology of the various types of chronic pruritic diseases, we will be able to judiciously use treatment targeting the underlying mechanisms better and thereby achieve more favorable results. It is important to understand that itch is a sensation of multi-dimensional nature. In addition to its somatosensory aspect, it is closely linked to emotion and cognition. Very often, chronic pruritus originates from an organic disease but is amplified by the psychology of the patient. It is important to check if there are psycho-social issues that accompanies the presentation of chronic pruritus, and addressing them provides for a more effective and holistic management to the condition. A multi-disciplinary clinic would be suited to better address these aspects. Such a multi-disciplinary clinic would typically comprise a dermatologist, a nurse educator, a psychologist, a psychiatrist and medical social worker. In summary, our current clinical management of itch can be improved through careful identification of the underlying cause/s, using therapies specific for the disease and targeting the pathological mechanisms, and adopting a holistic approach to the clinical problem.