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Comment & Response
November 2015

Careful Considerations Concerning Psychogenic Itch—Reply

Author Affiliations
  • 1Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
JAMA Intern Med. 2015;175(11):1861-1862. doi:10.1001/jamainternmed.2015.4680

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

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