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RAD 2025: World expert on the pathophysiology of itch Gil Yosipovitch, MD, answers questions on the disease of chronic itch and on the expanding options for targeted treatment. 

Q&A: Managing Chronic Itch With Renowned Investigator Gil Yosipovitch, MD 

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

Clinical Topics

What's This "Red Spot"?

For the 7 most common causes of dementia, the slideshow that follows summarizes 
1. The associated brain changes 
2. The estimated percentage of cases of dementia the cause is responsible for 
3. Symptoms of the dementia 

 is not a single disease and not all dementia is 

, a common misconception in the general public and likely among patients in your practice. The clinical syndrome called dementia is characterized by progressive decline in 

 ie, memory, executive function, language, visuospatial ability, and behavior, that is sufficient to cause difficulty with daily functioning. The underlying neuronal loss and dysfunction in nerve transmission are the result of neurodegeneration and/or cerebrovascular injury. 

The pathophysiology, symptomatology, and progression of dementia will vary by individual and by the underlying etiology. Mixed pathologies are common and particularly in older adults, but most people will present with symptom patterns that are characteristic of a major dementia subtype.

The slide show above, based on the Alzheimer's Association report, 

2025 Alzheimer's disease facts and figures, 

summarizes the brain changes, estimated prevalence, and the symptoms for dementia resulting from 7 common etiologies: 

Limbic‐predominant age‐related TDP‐43 encephalopathy (LATE)

Dementia is not a normal part of aging; although cognitive changes are expected in later adulthood, they are typically more subtle than the disruptive deviations of dementia. 

The progression of dementia, across all types, is typically described in 3 stages: early (mild), middle (moderate), and late (severe). Changes in the early stage are generally subtle, especially in memory or language, and often attributed to the aging process. As the neurodegenerative process continues, individuals need increasing assistance with instrumental and eventually basic activities of daily living. Behavioral and psychiatric symptoms, such as apathy, depression, disinhibition, and even delusions, may emerge, and in late-stage disease, patients often lose functional independence entirely.

Symptoms do frequently overlap but a precise diagnosis is essential as ongoing treatment, both pharmacologic and behavioral, may may have differential efficacy depending on the underlying etiology.

The brain changes that lead to cognitive and behavioral changes referred to as dementia have multiple potential etiologies; not all dementia is Alzheimer disease. 

7 Common Causes of Dementia: A Topline Review 

This asymptomatic, hyperpigmented, hairy lesion is on the left upper back of a 16-year-old boy. The pigmentation was first noted 5 years earlier; the coarse and dark hair confined to the hyperpigmented area had appeared at age 13 years. History and physical examination findings were unremarkable.

This asymptomatic, hyperpigmented lesion was first noted 5 years earlier on the left upper back of a 16-year-old boy. A nevus? Cafe au lait spot? 

Hairy Brownish Patch

The mother of a 10-year-old boy brings him in for evaluation of his moles (which are all benign). During the visit, the mother asks about the lesions on the first 2 knuckles of his right hand; she initially noticed them several months earlier. The boy is otherwise healthy.

White Knuckles

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma.

A 67-year-old woman noted the appearance of several non-tender, rock-hard, purple-colored nodules on her legs. Her medical history was significant for distant non-Hodgkin lymphoma. The violaceous color and configuration of the skin lesions suggests which of the following? 

Hard Purple Nodules: Your Dx?


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

Gil Yosipovitch, MD

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