• Government
• Profession
• Business
• Opinion
• Health

• Health reform
• H1N1
• P4P
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Book Excerpt
• Business Pitch
• Meetings
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Writers
• Other years

• Search tips
• E-mail alert
• Radio
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

Scratching the surface of an itchy question

Classifying the origin of pruritus into one of four new categories could lead to better treatment.

By Susan J. Landers, amednews staff. March 1, 2004.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE

Washington -- What exactly causes an itch? It's an everyday quandary of medicine. But finding a resolution -- and an effective treatment -- can leave doctors scratching their heads.

The usual suspects are always in the lineup: chickenpox, psoriasis, dry skin, insect bites, poison ivy and any number of allergies. But there's also the chance that the itch might be more than skin deep, a sign of obstructive liver disease, renal failure, hyperthyroidism, Hodgkin's disease or other lymphomas, or HIV.

The age-old problem is now receiving increased attention as new emphasis is being placed on classifying the itch's cause as a means to take advantage of more specific treatments.

Even with this development, challenges for physicians are significant.

"Itch is a very difficult symptom to understand and define," said Jeffrey D. Bernhard, MD, professor of medicine at the University of Massachusetts Medical Center in Worchester. He was part of a panel of experts addressing a February meeting of the American Academy of Dermatologists in Washington, D.C.

And defining it is only the beginning. "We know that sometimes itching patients are not easy patients," said Dr. Torello Lotti, professor of dermatology at the University of Florence in Italy. "There are some kinds of itch that are almost impossible to understand and treat."

In an effort to address this, a team of researchers recently developed a four-part system to differentiate among an itch's origins. For difficult cases, classifying the type of itch can be helpful, said Dr. Malcolm Greaves, emeritus professor of dermatology at the University of London. "You have to start somewhere."