Chronic itch is a common and distressing symptom that arises from a variety of skin conditions and systemic diseases. Despite this, there is no clinically based classification of pruritic diseases to assist in the diagnosis and cost-effective medical care of patients with pruritus. The proposed classification focuses on clinical signs and distinguishes between diseases with and without primary or secondary skin lesions. Three groups of conditions are proposed: pruritus on diseased (inflamed) skin (group I), pruritus on non-diseased (non-inflamed) skin (group II), and pruritus presenting with severe chronic secondary scratch lesions, such as prurigo nodularis (group III). The next part classifies the underlying diseases according to different categories: dermatological diseases, systemic diseases including diseases of pregnancy and drug-induced pruritus, neurological and psychiatric diseases. In some patients more than one cause may account for pruritus (category "mixed") while in others no underlying disease can be identified (category "others"). This is the first version of a clinical classification worked out by the members of the International Forum for the Study of Itch. It is intended to serve as a diagnostic route for better evaluation of patients with chronic pruritus and aims to improve patients' care.

effective for urticaria. Medications that modulate neurologic function, including gabapentin, are effective for recalcitrant pruritus and less sedating than oral antihistamines.2 Treatment of comorbid depression or anxiety can also improve the symptoms and burden of pruritus.Patients without a dermatologic, neurologic, or psychiatric cause for pruritus should be asked about the presence of fevers, chills, night sweats, and/or unintended weight loss, as well as undergoing a full review of systems to assess for localizing symptoms. Physical examination would include palpation of the lymph nodes, spleen, and liver. Testing for a metabolic or neoplastic source of pruritus should be considered for patients with chronic, generalized pruritus who lack a primary skin disease.3 Systemic evaluation of these patients can include malignant neoplasm and thyroid, renal, hepatic, and infectious diseases. 4 Thus, it is important to remember the association of chronic pruritus and internal systemic diseases but to limit screening to the patients without recognizable skin disease. LESS IS MORE Competing Mortality in Cancer Screening A Teachable Moment Story From the Front LinesA 70-year-old man saw his primary care clinician and ex pressed concern about his lung cancer risk after learning a friend had recently died of it. The patient had had an 80-pack-year history, and had quit 7 years previously. His physician ordered a screening chest computed tomographic (CT) scan, which demonstrated a spiculated 12-mm lung nodule that was new when compared with scans done previously for other reasons. This prompted a positron emission tomographic scan, which showed metabolic activity, raising the suspicion for lung cancer. He was referred to a pulmonary-nodule clinic. The man presented to the pulmonary clinic in a wheel chair while receiving continuous oxygen. His medical history revealed severe diastolic heart failure; chronic obstructive pulmonary disease; obesity (his body mass index, calculated as weight in kilograms divided by height in meters squared, was 54); diabetes mellitus with microvascular complications, including stage III chronic kidney disease; and peripheral neuropathy. Additional medical history included several recent falls attributed to progressive neuropathy and deconditioning. These considerations were discussed with the patient and ultimately, invasive diagnostic testing was discouraged. A conservative plan that included a repeated CT scan in 4 months was mutually agreed on. Two months after this visit, the patient was admitted and treated for pneumonia. While recovering in the hospital, his primary team noted that this nodule had not undergone workup and he had another CT scan, which demonstrated interval growth. He was scheduled for an outpatient CT-guided biopsy.Prior to the biopsy, the patient was rehospitalized for pneumonia, this time requiring intensive care unit admission. His medical history was addressed at a multidisciplinary thoracic tumor conference. He was not a surgical candidate, and attempts to biopsy...

ActaDV is a journal for clinical and experimental research in the field of dermatology and venereology and publishes highquality papers in English dealing with new observations on basic dermatological and venereological research, as well as clinical investigations. Each volume also features a number of review articles in special areas, as well as Correspondence to the Editor to stimulate debate. New books are also reviewed. The journal has rapid publication times.

This new definition and terminology of CPG should be implemented in dermatology to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future, the cross-sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific investigation of CGP.