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

Chronic itch is the most burdensome symptom of atopic dermatitis (AD), yet its routine assessment and measurement remain inconsistent. 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. 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. 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. 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.