Transforming an often underestimated symptom into a clinical priority to be treated with increasingly advanced and personalized tools. This is the step proposed by dermatologists from SIDeMaST, gathered in Rome for the 99th national congress. A clinical priority, first and foremost because behind an "itch" may lie a disease or even a psychological disorder that needs to be uncovered. There is no one-size-fits-all itch: with the same diagnosis, different patients may present different biological mechanisms, influenced by factors such as age, gender, comorbidities, ongoing therapies, and genetic characteristics, as well as varying physical and psychological consequences. "In dermatology, we are experiencing a true paradigm shift: we no longer treat just the symptom, but the patient in their biological specificity," emphasizes Paolo Amerio, Professor of Dermatology and President of the 99th SIDeMaST congress. "Personalized medicine allows us to identify the mechanisms underlying the itch and intervene with increasingly targeted and effective therapies." A profound impact on quality of life. Today we know that chronic itching is not just a physical symptom. "Itching affects not only the skin but the entire emotional and relational sphere of the person," explains Roberto Maglie from the University of Florence. It can promote anxiety and depression in about 20% of patients, impair sleep in 60% of cases, and create significant psychosocial distress, leading to stigmatization and isolation, as it is linked in the collective imagination to the idea of contagion. This creates a vicious cycle that reinforces psychological stress, worsens quality of life, and makes clinical treatment more difficult. Itching is the main symptom of most chronic inflammatory skin diseases, such as Psoriasis and Atopic Dermatitis, and also appears in parasitic diseases. However, it is often associated with systemic diseases: hematological conditions like lymphomas and polycythemia, liver and kidney failure. Sometimes it can even be a medical emergency, as in the case of cholestatic itching during pregnancy, which can affect the course of pregnancy and fetal survival. But the cause is not always organic. Itching may reflect a psychological disorder (psychogenic itching) or, despite in-depth analyses, remain without an identifiable cause, being termed "chronic itching of unknown origin." Scientific research has made significant progress in understanding the mechanisms. In addition to histamine, which until recently was considered the main culprit of itching, many other inflammatory mediators, called "pruritogens," have been identified in various chronic inflammatory diseases such as atopic dermatitis, psoriasis, and other systemic conditions. "These inflammatory mediators interact with immune cells, skin cells, and neural networks, involving both the peripheral and central nervous systems, producing the characteristic itching response."