{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:35:32Z","timestamp":1786473332102,"version":"build-2736575974"},"reference-count":17,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic itch is common in primary care but is often under-examined, partly because clinicians lack a clear mechanistic framework for interpreting its diverse presentations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To provide generalists with a practical, mechanism-based model for assessing and managing chronic itch.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Evidence from neurobiology, dermatology, and internal medicine was synthesised into a four-driver framework describing skin-generated, systemic, peripheral nerve, and centrally mediated itch. Clinical patterns, mechanistic pathways, and aligned treatments were integrated into a unified model for primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most chronic itch can be understood through a small number of mechanisms: keratinocyte stress and inflammatory cytokines in skin-generated itch; circulating mediators and neurohumoral imbalance in systemic itch; focal nerve injury in neuropathic itch; and sensitisation, amplification and conditioned scratching in centrally mediated itch. These mechanisms map to distinct clinical patterns and targeted therapeutic strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A structured assessment focusing on tempo, distribution, skin findings, systemic clues, and sensory change supports clearer diagnosis and more effective management of chronic itch in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/postmj\/qgag097","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T11:45:09Z","timestamp":1783424709000},"source":"Crossref","is-referenced-by-count":0,"title":["Understanding chronic itch: a mechanistic framework for primary care"],"prefix":"10.1093","author":[{"given":"Jawad","family":"Mahmood","sequence":"first","affiliation":[{"name":"Independent Medical Educator & Clinician, Finchley , London N3 ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081113480560500_ref1","doi-asserted-by":"crossref","first-page":"1625","DOI":"10.1056\/NEJMcp1208814","article-title":"Chronic pruritus","volume":"368","author":"Yosipovitch","year":"2013","journal-title":"N Engl J Med"},{"key":"2026081113480560500_ref2","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1038\/nrn1950","article-title":"The neurobiology of itch","volume":"7","author":"Ikoma","year":"2006","journal-title":"Nat Rev Neurosci"},{"key":"2026081113480560500_ref3","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.neuron.2018.03.023","article-title":"Peripheral and central mechanisms of itch","volume":"98","author":"Dong","year":"2018","journal-title":"Neuron"},{"key":"2026081113480560500_ref4","doi-asserted-by":"crossref","first-page":"469","DOI":"10.2340\/00015555-3164","article-title":"European S2k 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