Beyond the Skin: Assessing Itch in Atopic Dermatitis – Insights from UK Dermatologists. A Cross-Sectional Survey and Narrative Review

BACKGROUND: Chronic itch is the most burdensome symptom of atopic dermatitis (AD), yet its routine assessment and measurement remain inconsistent. OBJECTIVES: This study aimed to characterise current practices for evaluating itch in AD among UK dermatologists and, through a narrative review, to summarise available itch assessment tools and inform practical recommendations for routine practice. DESIGN: This was a cross-sectional clinician survey and narrative literature review. A total of 394 dermatologists participated in the survey of itch and its assessment in AD during the 2024 British Association of Dermatologists Annual Meeting. RESULTS: Dermatologists reported itch as the most bothersome symptom in atopic dermatitis (78.68%, n = 310), and nearly half identified itch as the strongest predictor of disease severity (47.97%, n = 189). Only 28.68% of respondents (n = 113) reported assessing itch often or always using the peak pruritus numerical scale (PP-NRS) or visual analogue scale (VAS), while 45.18% (n = 178) assessed itch sometimes and 26.14% (n = 103) never assessed itch. Reduction of itch was selected as the most important treatment goal by 56.35% of respondents (n = 222). In addition, 94.16% (n = 371) agreed or strongly agreed that they routinely try to understand the impact of itch on their patients, and 74.11% (n = 292) agreed or strongly agreed that there is currently a lack of effective treatment options for itch relief. The narrative review identified validated unidimensional itch measures (numerical rating scale (NRS), VAS, verbal rating scale (VRS)) and multidimensional instruments (Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), 5-D itch scale, ItchyQOL), with clinical studies reporting that reductions of approximately 3-4 points on the itch NRS correspond to patient-perceived meaningful improvement. CONCLUSION: This large UK-based survey among dermatologists highlighted a gap between recognition of itch burden in atopic dermatitis and its systematic measurement in routine practice. The accompanying narrative review identified simple patient-reported measures, including the numerical rating scale (NRS), as feasible options to support more consistent itch assessment in routine care.