Chronic itch occurs frequently and is a highly distressing symptom, which is associated with a large variety of cutaneous, neuropathic and systemic conditions. The recent advancements in our understanding of itch transmission enables a coherent approach to antipruritic treatment in various common diseases, but accurate diagnosis remains vital. Based on the International Forum for the Study of Itch 2007 classification system this review summarises the first rational clinically based approach to categorising chronic itch conditions. Furthermore, the antipruritic treatment options available for each of the major four aetiological itch condition subcategories are presented.