We appreciate the interest and comments of Drs. Mahajan, Gupta, and Sharma regarding our Review Article about postoperative pruritus.1In our Review Article, we summarized coexisting conditions that contribute to the choice of anesthesia and treatment of postoperative pruritus. Two major purposes for our article were (1) to summarize up-to-date knowledge about prevention and treatment of itching after surgery and (2) to illustrate basic principles for diagnosis and treatment for postoperative itching for practicing anesthesiologists. We appreciate the suggestions of Dr. Mahajan et al.  2that anesthesiologists should be vigilant about the Koebner phenomenon in patients with certain skin diseases and avoid the use of medications that would lead to pruritus.

In a variety of skin diseases, trauma to the skin may result in the isomorphic Koebner phenomenon.3–5We would like to emphasize that exacerbation of coexisting skin disease is not a sequela to pruritus. To the best of our knowledge, there is no study that linked mechanisms of pruritus with the Koebner phenomenon. Of course, if itching is left untreated, it may lead to scratching, and trauma caused by scratching (but not to itching per se ) may cause the Koebner phenomenon. Our review focused on early diagnosis and treatment of pruritus not only to avoid sequelae of itching (scratching, as well as the isomorphic Koebner phenomenon in certain cutaneous diseases), but also to improve patients’ satisfaction and to shorten their time in the recovery room. In addition, we emphasized the increasing need for effective preventive measures, which are often still missing.

Also, we think that in the future, anesthesiologists will have access to more specific drugs that will act only at the intended receptor. With them, anesthesiologists will be able to modulate specific sites for specific anesthetic and surgical goals instead of causing undesirable effects (such as itching).

*John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois. bwaxler@rush.edu

Waxler B, Dadabhoy ZP, Stojiljkovic L, Rabito SF: Primer of postoperative pruritus for anesthesiologists. Anesthesiology 2005; 103:168–78
Mahajan R, Kumar Grover V: Neuraxial opioids and Koebner phenomenon: Implications for anesthesiologists. Anesthesiology 2003; 99:229–30
Rubin AI, Stiller MJ: A listing of skin conditions exhibiting the Koebner and pseudo-Koebner phenomena with eliciting stimuli. J Cutan Med Surg 2002; 6:29–34
Jolly M: Discoid lupus erythematosus after tattoo: Koebner phenomenon (letter). Arthritis Rheum 2005; 53:627
Durani BK, Kurzen H, Hartschuh W, Naeher H: Koebner phenomenon due to scratch test in scleromyxoedema. Br J Dermatol 2001; 145:306–8