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In Reply We thank Dr Elmariah for her letter and the chance to further discuss pruritus, a condition that is important to both patients and clinicians. We feel there are some generalizable principles that can be used to guide the evidence-based care of many patients with pruritus.
Classifying pruritus as dermatologic, neurogenic, psychogenic, and/or systemic can help guide clinicians to explore the history and decide on an appropriate physical examination when evaluating and managing a patient.1 Dr Elmariah’s letter is a helpful reminder to clinicians to evaluate patients’ progress and be willing to rethink prior diagnoses. Patients may have 2 or more causes of pruritus, spanning multiple categories or, as Dr Elmariah points out, systemic or dermatologic diseases may become evident later.2
Kirby JS, Smucker J. Careful Considerations Concerning Psychogenic Itch—Reply. JAMA Intern Med. 2015;175(11):1861-1862. doi:10.1001/jamainternmed.2015.4680