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Comment & Response |

Careful Considerations Concerning Psychogenic Itch—Reply

Joslyn S. Kirby, MD1; Joanne Smucker, MD1
[+] 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.
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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


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November 1, 2015
Sarina B. Elmariah, MD, PhD
1Cutaneous Biology Research Center, Department of Dermatology, Massachusetts General Hospital, Boston
JAMA Intern Med. 2015;175(11):1861. doi:10.1001/jamainternmed.2015.4677.
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