Scratching the surface: The challenges of treating itching

Itching is poorly understood, but scientists are recognizing that this sensation may be more different from pain than previously thought.

By Victoria Stagg Elliott, AMNews staff. Jan. 21, 2008.

In the early days of his career, Gil Yosipovitch, MD, was an internist on call for hemodialysis patients. He discovered that, although they had obvious life-threatening medical needs associated with their kidney disease, they also commonly experienced a symptom that destroyed their quality of the life. They itched -- and it made them miserable.

"I saw how much these patients were suffering. In my opinion, they are like chronic pain sufferers. No sleep -- suffering, scratching all night," he said.

He is now a dermatologist and part of a cadre of physicians and scientists turning their attention to what causes itching and what can be done to alleviate the need to scratch. Dr. Yosipovitch, also a professor of dermatology, neurobiology and anatomy at Wake Forest University in Winston-Salem, N.C., founded the International Forum for the Study of Itch in 2005. The organization, which receives financial support from the National Institutes of Health, sponsored the fourth international meeting on this topic in San Francisco in September 2007.

Previously, "there were no itch meetings," he said. "Dermatologists won't go to pain meetings. Neuroscientists will never go to dermatology. Itch meetings combine all these people."

The scientific challenge he and others now face is significant. Itching has hundreds of causes from bug bites to the side effects of chemotherapy, but the amount of research money devoted to its study has long paled in comparison to pain. This circumstance arises, in part, because itching has generally been considered a lesser version of pain, although research is emerging to suggest that the relationship is far more complicated. Itch research could lead to a greater understanding of pain because, like sibling rivals, itch and pain may be closely intertwined at certain times, but very much separate at others.