Clinical and Psychological Impact of Pruritus Related to Skin Barrier Damage

Many external and internal factors can affect skin lipid synthesis and composition, which may impair skin barrier function, and potentially cause skin dryness, pruritus and other sensory symptoms. Pruritus, frequently associated with xerosis—particularly in inflammatory skin diseases, such as atopic dermatitis (AD)—is a commonly reported dermatological symptom in the general population. This narrative review, based on conference proceedings from clinicians and dermatologists, discusses the clinical and psychological impact of pruritus on individuals experiencing this subjective symptom. Starting with a summary of the key mechanisms involved in the itch–scratch cycle and signaling pathways shared with pain sensation, this review highlights the significant impact of chronic pruritus and associated symptoms, including sleep disturbances, on quality of life (QoL) and mental health. One of the main conclusions emerging from discussions between experts was that pruritus is a symptom with strong psychological features, which can easily become chronic under stressful conditions, and significantly affect patients’ daily life and well-being. Therefore, the psychological issues associated with chronic pruritus, such as anxiety and depression, must not be overlooked, and dermatologists should perform a general psychodermatological assessment of patients with chronic pruritus for effective management of their dermatological and underlying psychological symptoms according to current guidelines. Management options need to include supportive skincare products and medical approaches to relieve symptoms of skin barrier dysfunction and chronic inflammation, as well as holistic strategies to help manage the psychological consequences of chronic pruritus. If concomitant psychopathologies are diagnosed, tailored drug treatments should be considered on a case-by-case basis to adequately address them.