Comprehensive Strategies for Managing Pruritus: Insights from Adam Friedman, MD

In a pivotal session at the DERM 2025 NP/PA CME Conference held from July 23-26, 2025, in Las Vegas, Nevada, Dr. Adam Friedman, a prominent figure in dermatology and the director of translational research at The George Washington University School of Medicine & Health Sciences, presented crucial strategies for diagnosing and treating pruritus, a condition characterized by intense itching.

Dr. Friedman emphasized the importance of differentiating between an itch causing a rash and a rash causing an itch, stating, "This distinction sets the clinician on two distinct paths for treatment." He recommended a comprehensive initial workup, including a complete blood count (CBC) and metabolic panel, to uncover underlying causes such as kidney, liver, and thyroid issues, as well as potential malignancies like lymphoma.

Friedman's approach to pruritus is systematic and thorough. He advises clinicians to conduct a head-to-toe examination, regardless of whether the patient presents with a visible rash. "Do not forget that pruritus can be a presenting sign of various malignancies, with lymphoma being particularly notable," he cautioned. The necessity of chest X-rays in certain cases was also highlighted as a critical step in diagnosis.

Regarding treatment, Dr. Friedman advocated for aggressive and multifaceted strategies. He outlined the use of topical Janus kinase (JAK) inhibitors and phosphodiesterase-4 (PD-4) inhibitors as leading therapeutic options due to their unique effects on sensory neurons. Additionally, he suggested a combination of systemic therapies, such as gabapentinoids and selective serotonin reuptake inhibitors (SSRIs), to target neuropathic pain in conjunction with anti-inflammatory medications.

"Think creatively and climb the therapeutic ladders that focus on nerves and inflammation," Dr. Friedman advised, underscoring the need for a tailored approach to meet the individual needs of patients.

The DERM 2025 conference served as a platform not only for Dr. Friedman's insights but also for discussions on the broader implications of pruritus management in dermatological practice. Experts recognized that pruritus affects countless individuals globally, significantly impacting their quality of life.

According to a report published in the Journal of Dermatological Treatment in April 2024, pruritus prevalence ranges from 10% to 20% in the general population, with higher rates among patients with skin disorders (Smith et al., 2024).

In conclusion, Dr. Friedman’s strategic and organized methodology offers an essential framework for dermatologists grappling with the complexities of pruritus. His emphasis on aggressive treatment and thorough diagnostic processes highlights the importance of a comprehensive approach in delivering effective patient care. As dermatological research continues to evolve, the insights shared at DERM 2025 will undoubtedly inform future practices in the management of pruritus and related skin conditions.