Pruritus is a common complaint in systemic sclerosis (SSc) and impairs patients' quality of life. Little is known about the pathogenesis of itch in SSc, but complex and multi-factorial mechanisms of itch are appreciated in many chronic diseases. This review discusses the putative mechanisms of the pathogenesis of itch to better understand the mechanisms that may be relevant to pruritus in SSc. It discusses possible therapeutics in the context of this complex pathogenesis.