One of the most difficult struggles many patients with dermatologic diseases face over the course of their condition is chronic pruritus, also known as itch. This topic was covered in a session at the Dermatology Education Foundation (DERM) 2025 NP/PA CME Conference.
Addressing chronic pruritus and managing this symptom of disease was highlighted in a new HCPLive interview with Adam Friedman, MD, who serves as Professor, Chair of Dermatology, Residency Program Director, Director of Translational Research, and Director of the Supportive Oncodermatology Program in the George Washington University School of Medicine & Health’s Department of Dermatology.
“I think one of the greatest struggles when it comes to managing a patient with pruritus, which, you have to understand, can be a symptom or a disease unto itself,” Friedman said. “Is it an itch that rashes, meaning you are manipulating the skin by scratching and now create visible change, or is a rash that itches a primary skin disease that is pruritic? That single question will veer you off into 2 very different directions. I would argue a rash that itches is probably a little easier to manage, because there are a plethora of possible things that can be driving the itch with no obvious primary cutaneous issue. With that in mind, you want an organized approach in order to figure out what could be driving disease.”
Friedman spoke about some of the initial focus of labwork, including checking on issues with the liver, kidneys, and thyroid. He went on to discuss pruritus as a potential presenting sign of different forms of malignancy.
“A chest X-ray I would certainly recommend in the right setting,” Friedman explained. “That is definitely one of the key takeaways: do not forget, pruritus can be a presenting sign of many different flavors of malignancy. Probably the best known would be lymphoma, and that’s where the chest X-ray comes in. Other key things not to miss know that bullous pemphigoid can just present as pruritus. Anywhere from 10 to 15% of patients can have no skin findings. Also, you never want to be humbled by scabies.”
Friedman later went on to describe tips regarding treatment options for patients suffering from chronic itch.
“We do have OTC and prescription options that are available to us,” Friedman said. “Probably the hottest thing out there is going to be your topical JAK inhibitors and PDE4 inhibitors, both of which have a unique influence on sensory neurons. Systemically, the take-home is that you should take a little from Aisle A, take a little from Aisle B, meaning go after neuropathic or nerve targeting therapies like SSRIs, gabapentinoids, in combination with anti-inflammatories. If it is a mixed picture, fortunately, we have some really amazing systemic agents that are meant to address inflammation but also will hit itch. I mentioned JAK inhibitors before, but we have a litany of biologics that target key cytokines or receptors that drive both inflammation and sensitization of those neurons. So be creative. Ask lots of questions.”
For any additional information on the topics covered by Friedman in his session, view the full video segment posted above this summary. For more, view our latest conference coverage.
The quotes used in this interview description were edited for clarity.
Friedman has previously reported serving as a consultant to Dermira, Eli Lilly and Company, Encore Dermatology Inc, Exeltis, Galderma, IntraDerm, Johnson and Johnson, Oculus Innovative Sciences, Pfizer Inc, and Sanovaworks.