Decades of 'Unexplained Itching' Now Treated at Multidisciplinary Specialty Center

First Intractable Pruritus Center Launched in Korea
Multidisciplinary Collaboration Led by Dermatology
One-Stop Precision Diagnosis and Personalized Treatment

"When a patient is in pain, people around them say, 'That must hurt,' but when someone says they're itchy, the response is often, 'Just endure it.' In reality, it leads to sleepless nights, and even severe depression and anxiety."

On May 18, in front of the waiting area of the Intractable Pruritus Center located on the first floor of the New Building 2 at Hallym University Kangnam Sacred Heart Hospital in Yeongdeungpo-gu, Seoul, a notable number of patients waited for their turn, despite the center having officially launched less than a month ago. On this day, Kim Hyewon, Head of the Intractable Pruritus Center (Professor of Dermatology), personally guided visitors through the facility. This center, which approaches itch not as a 'bearable discomfort' but as a 'disease requiring treatment,' is the first multidisciplinary cooperative specialist center of its kind in Korea, and was officially launched on April 29.

On the 18th, Kim Hyewon, Director of the Intractable Pruritus Center, is speaking at the Intractable Pruritus Center of Hallym University Gangnam Sacred Heart Hospital in Yeongdeungpo-gu, Seoul. Photo by Kwak Minjae

The Intractable Pruritus Center at Hallym University Kangnam Sacred Heart Hospital has established a multidisciplinary cooperative system centered on the Department of Dermatology, with participation from the Departments of Internal Medicine, Neurology, Otorhinolaryngology, Obstetrics and Gynecology, and Psychiatry. The main focus is on patients with intractable pruritus whose causes are difficult to identify or who do not respond to conventional treatments, as well as those suspected to have links with systemic diseases. ▲ Cases where symptoms persist for more than four weeks despite treatment with topical steroids or antihistamines ▲ Cases where severe itching and sleep disturbances persist for a long period ▲ Cases where only generalized itching occurs without skin lesions ▲ Cases such as moderate or more severe atopic dermatitis or prurigo nodularis, where biologics or targeted therapies are considered, all require more active evaluation. Kim emphasized, "Among chronic pruritus patients, there are quite a few who have not been able to identify the cause for years or even decades, despite repeated antihistamine and steroid treatments. Rather than merely suppressing symptoms, a precise diagnosis that evaluates lifestyle habits, medications, and the presence of systemic diseases together is the starting point for treatment."

Chronic pruritus can be caused not only by skin diseases but also by systemic diseases such as liver, kidney, or thyroid disorders, allergies and immune abnormalities, neurological diseases, and hematological malignancies. It can also be caused by medications, including antihypertensives, diuretics, analgesics, anti-inflammatories, and anticancer drugs, making a thorough evaluation of causes necessary. Clinically, it is classified as follows: ▲ Dermatological, with skin lesions such as atopic dermatitis or psoriasis ▲ Systemic or neuropathic, appearing without skin lesions, as in thyroid disease or chronic kidney disease ▲ Secondary skin lesion type, where nodules form due to repeated scratching. When itching occurs, scratching damages the skin barrier and amplifies inflammation, so if the 'itch-scratch vicious cycle' is not broken early, it can lead to chronic and severe conditions. Senile pruritus is also an important area of attention. In elderly patients, in addition to decreased skin barrier function, changes in sensory nerves, immune aging, polypharmacy, and chronic diseases act in a complex manner. This is why it should be approached not as simple skin aging, but as a 'complex disease.'

A patch test is being applied to the back of a patient with chronic itching to identify the cause of contact allergy. Hallym University Medical Center

The center comprehensively evaluates symptoms, aggravating factors, medications taken, living environment, and comorbidities, then sequentially conducts blood tests, skin biopsies, patch tests, and skin barrier assessments. Treatment responses are then evaluated at 2- to 4-week intervals, and therapeutic strategies are adjusted accordingly. The patch test is a key element, used to trace contact allergy causes in daily life—such as hair dyes, metals, fragrances, detergents, cosmetics, and rubber—which are difficult to identify with blood tests alone. For chronic pruritus patients who have not found a cause despite long-term repeated treatments, it often provides diagnostic clues.

Treatment goes beyond conventional antihistamines to directly target immune and neural pathways. For patients with severe atopic dermatitis, prurigo nodularis, or senile pruritus, narrowband UVB (NB-UVB) therapy and excimer laser therapy are applied, along with LED therapy using wavelengths that alleviate skin inflammation. Additional options include JAK inhibitors, which modulate immune responses and inflammatory signals; biologics that selectively block specific immune mediators; antipruritic agents that control opioid receptors involved in itch signaling; and gabapentinoid antipruritic agents that relieve excessive neural itch signals. The center has established a one-stop care system linking precision personalized treatment to clinical research. Kim stated, "Treatment for intractable pruritus is a process of first identifying the cause of the itch and then stepwise adjusting the treatment strategy based on response. We plan to establish a national standard care system for intractable pruritus through the development of patient registries and clinical research."

The Intractable Pruritus Center at Hallym University Kangnam Sacred Heart Hospital plans not only to provide patient care, but also to improve diagnostic accuracy and access to treatment by establishing standardized clinical data for patients, developing educational materials by disease, and facilitating academic exchanges with local medical institutions. Lee Dongjin, Director of Hallym University Kangnam Sacred Heart Hospital, said, "The opening of this center is intended to provide accurate diagnosis and treatment opportunities to patients who have suffered from chronic pruritus for decades without knowing the cause. We are committed to creating an environment where patients no longer have to endure alone and can actively receive treatment."

This content was produced with the assistance of AI translation services.