Pruritus: more scratch than itch

Itch is one of the major symptoms of skin disease although it remains poorly studied. Little is known about its mediators or the neurological processes involved in either the detection of an itch stimulus or the induction of the main response to itch, scratch. This lack of knowledge may be due to the subjective nature of the sensation itself and the related difficulties in quantifying it, and is compounded by the absence of a convincing animal model. Defining itch as that sensation which provokes the desire to scratch provides two approaches to measurement, that of itch itself, and the behavioural response, scratch. The measurement of itch itself traditionally involves the use of questionnaires or visual analogue scale, both of which rely on the dubious assumption that the subject is able to relate their experiences accurately. By contrast experimental induction of itch and measurement of areas of allokinesis around application sites may provide a more reliable and repeatable method of itch quantification. Recent advances in two areas that may prove relevant are discussed: new technological improvements in movement meters and compatible software; and some recently described animal models.