The problems of itch in burns patients are well recognised, however none of the current standard therapies are very effective. The standard therapies include: antihistamines which are only effective in about 20% of patients and emollients which have limited effects. We review the current literature on the molecular mechanisms of itch and neuronal itch pathways, which supports the predictable lack of effect of anti-histamines. The published studies on therapeutic options to treat itch in burns are discussed and in addition we review the work on the treatment of itch in other pathological states. Finally a treatment algorithm is proposed stratifying possible therapeutic options to assist in the management of burns patients distressed by intractable itch.