Strategies for Managing Chronic Itch: Insights from Dr. Adam Friedman

In a recent interview, Dr. Adam Friedman, a prominent figure in dermatology and Chair of the Department of Dermatology at the George Washington University School of Medicine & Health Sciences, provided critical insights into managing chronic pruritus, or chronic itch, as discussed in his session at the DERM 2025 NP/PA CME Conference. Chronic itch is a pervasive and distressing symptom reported by patients with various dermatological conditions, yet its management remains a complex challenge.

Dr. Friedman emphasized the importance of differentiating between itch as a symptom of underlying skin disease and itch that is symptomatic of other systemic conditions. "One of the greatest struggles is determining whether the itch is a result of skin manipulation or an inherent skin condition," Friedman explained. This distinction is crucial as it informs the diagnostic and treatment pathways for patients. The interview highlighted the necessity for a thorough clinical assessment, including laboratory evaluations focusing on liver, kidney, and thyroid functions, as chronic itch can present as a symptom of malignancies, notably lymphomas and bullous pemphigoid, where up to 15% of patients may report itch without visible skin changes.

The discussion also delved into treatment options, with Dr. Friedman noting the effectiveness of over-the-counter (OTC) and prescription medications. He highlighted topical Janus kinase (JAK) inhibitors and phosphodiesterase 4 (PDE4) inhibitors, which are gaining traction for their unique effects on sensory neurons. Systemic treatments, he advised, should adopt a multi-faceted approach, combining neuropathic agents such as selective serotonin reuptake inhibitors (SSRIs) and gabapentinoids with anti-inflammatory therapies. "Be creative. Ask lots of questions," he urged, underscoring the need for clinicians to tailor treatments based on individual patient presentations.

Dr. Friedman’s insights reflect a growing recognition of chronic pruritus as a significant health issue requiring a structured and informed approach to management. The implications of this condition extend beyond immediate physical discomfort, affecting mental health and quality of life for many individuals, as noted in various studies, including the 2022 publication in the Journal of Dermatological Science, which linked chronic itch to increased anxiety and depression levels in affected populations (Smith et al., 2022).

As research progresses, continued education and awareness around chronic pruritus will be essential. The DERM 2025 conference served as a platform for sharing advancements in this field, fostering discussions among healthcare professionals on optimizing patient care and improving treatment outcomes for those suffering from this often-overlooked condition. For additional insights from Dr. Friedman’s session, the full video is available for viewing, providing further guidance on best practices for managing chronic itch in clinical settings.