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In the past, much work has been devoted to psychosomatic dermatology (or psychodermatology) by well-known pioneers. In recent years, the molecular mechanism by which neuropeptides (NPs) link the neural-immune-endocrine axis has been receiving increasing attention. This bidirectional communication between the immune-endocrine system and the nervous system also involves soluble factors, such as neurotransmitters and cytokines, that are produced by each system. It is also well known that the skin contains numerous NPs released from the sensory nerves and produced by the resident cells of the immune system or by skin cells. Functional dysregulation of NPs has been associated with pathologic cutaneous conditions, such as psoriasis and atopic dermatitis, and the current understanding of the bidirectional loops between the immune-endocrine system and the central and autonomic nervous systems may clarify the pathophysiology of these diseases, thus providing potential targets for therapeutic interventions. General concepts 1-3NPs are a heterogeneous group of molecules consisting of two or more of the 40 amino acids that are present in the central and peripheral nervous systems, where they act as neurotransmitters and/or neuromodulators producing specific biological activities. Several studies have demonstrated, in particular for substance P (SP), calcitonin gene related peptide (CGRP) and vasoactive intestinal peptide (VIP), NP synthesis and release by different cells in the skin and by a subpopulation of small unmyelinated afferent neurons (C fibers or C polymodal nociceptors) and small myelinated Aδ fibers localized in human dermis and epidermis. NPs act as neurotransmitters of the afferent system and are responsible, as neuromodulators, for neurogenic

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We studied blood histamine activity (HA) and cutaneous fibrinolytic activity (CFA) in a patient with polycythaemia rubra vera (PRV) and water-induced pruritus, before and after water exposure. The results suggest that the water-induced itching in PRV is associated with an increase in HA. In addition, markedly increased levels of CFA were found both before and after water exposure. These findings have been previously reported in patients with aquagenic pruritus (AP) but not in patients with PRV. As the water-induced itching in PRV and AP share many common features, these findings suggest that the pathophysiology of the water-induced pruritus in these two conditions may be similar.