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Itch: Mechanisms and Management of Pruritus
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Jeffrey D. Bernhard; ed. 454 pages. New York: McGraw-Hill; 1994. $50.00.
Itching is second only to disfigurement as a source of patients' distress about their skin. It is the most common symptom of skin disease, afflicting millions of persons with atopic dermatitis (eczema), psoriasis, urticaria, and various other dermatoses. Nevertheless, it is poorly understood in most instances and, perhaps because of this, has been a relatively neglected topic in medical and dermatologic textbooks. Indeed, this is the first single comprehensive book devoted to pruritus. In Itch, Jeffrey Bernhard provides dermatologists and all other physicians who manage skin disease a much-needed reference about what is known and what is not, as well as specific recommendations about the evaluation and treatment of patients with pruritus.
Twenty-one contributors, all but one of whom are clinicians, provide in-depth coverage of the pathophysiology and distinguishing characteristics of pruritus in various dermatologic and systemic diseases, the psychogenic aspects of pruritus, and therapy. With few exceptions, the chapters are balanced and well referenced. Many reflect the authors' broad personal experiences; others represent the compulsive thoroughness of trainees and junior faculty members entrusted with somewhat arcane topics.
One of the more charming aspects of the book is the frequent use of quotations, ranging from the illustrated Shel Silverstein poem "Unscratchable Itch" to Huckleberry Finn's description of his personal itches to philosophical comments by Samuel Johnson. This combination of a rigorous critique of the medical literature and musing on the human condition reflects Dr. Bernhard's personal approach to pruritus and compensates—at least in part—for the paucity of hard facts. This latter problem is, of course, not a fault of the contributors, who rather are to be congratulated for assembling an often disparate literature so effectively. Itch belongs in the library of every medical school and dermatology department, as well as in the personal collection of any physician with more than a passing interest in this challenging subject.
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