Chronic pruritus is itching that lasts six weeks or longer, with or without a visible rash. It is one of the most disruptive symptoms in dermatology because it interferes with sleep, concentration, and mood, and because scratching damages the skin and feeds the cycle. Itch can come from the skin itself (eczema, dry skin, urticaria, scabies), from nerves, from internal conditions (kidney or liver disease, thyroid disorders, iron deficiency, lymphoma), or from medications, including several cancer therapies.

What causes chronic itching?

When there is a rash, the rash is usually the cause. When the skin looks normal, the workup looks inward: labs for kidney, liver, thyroid, and blood counts; a medication review; and attention to dryness, which is the most common cause in older adults. Itch during cancer treatment is often caused by targeted therapies, immunotherapy, or the disease itself.

What does prurigo nodularis have to do with itch?

Prurigo nodularis is a condition where months of scratching produce firm, intensely itchy bumps that keep the cycle going. It is now treatable with targeted biologic therapy, and recognizing it changes the plan.

How is chronic itch treated?

Repairing the skin barrier with emollients, treating any underlying rash, and calming the nerve signal with topical or oral medications. For itch that does not respond, dupilumab, nemolizumab, and other targeted therapies are options, as are treatments aimed at the nerve pathway. When an internal cause is found, treating it resolves the itch.

How Tono treats chronic itch

Tono's board-certified dermatologists see patients with chronic itch within days, not months, by video visit in 33 states and in person at Tono clinical centers. We treat itch as a diagnosis to be made, not a symptom to be soothed. Labs can be ordered before your visit, and our supportive oncodermatology team manages itch caused by cancer therapy in coordination with your oncologist so treatment continues. Your visit ends with a written plan, prescriptions sent to your pharmacy, and follow-up scheduled with the same dermatologist. Most insurance is accepted and no referral is required.

When should I see a dermatologist for chronic itch?

See a dermatologist if itching has lasted more than six weeks, wakes you at night, has no visible cause, or started with a new medication or cancer treatment.