Pruritus is considered a very frequent symptom and defined as chronic when its duration is longer than 6 weeks. The prevalence and the etiology of chronic pruritus (CP) are associated with various factors such as, age, atopy, underlying diseases, ethnicity, climate and humidity, as well as access to local healthcare system. The CP significantly affects the patients’ quality of life. Over time, patients often report sleep and mood disorders, with a negative psycho-social impact. From skin to brain, pruritus transmission occurs via multiple pathways, which are regulated by numerous cells, mediators, and receptors. A complete history and careful clinical examination are the keys to the diagnostic approach and determining treatment steps. Dermatological examination is essential and sometimes, an extensive laboratory testing must be carried out. The complexity in the presentation of this symptom, its obscure pathophysiology and multifactorial etiology, and the absence of clearly defined therapeutic goals, make CP a diagnostic and therapeutic challenge.