In this educational video, Christopher Bowlus, MD, the Chief of Gastroenterology at the University of California Davis and Lena Valente Professor, provides a comprehensive overview of current pharmacologic and non-pharmacologic strategies for managing pruritus (itch) in patients with Primary Biliary Cholangitis (PBC). He explains why pruritus is one of the most common and under recognized symptoms of PBC, affecting up to 80% of patients, and highlights the importance of proactively asking patients about itch using validated tools such as the Numeric Rating Scale (NRS). The discussion explores how itch impacts quality of life, sleep, and social functioning, and reviews practical assessment strategies in clinical practice. Dr. Bowlus walks through conservative measures, historical therapies such as bile acid sequestrants and antihistamines, and their limitations, before focusing on emerging evidence-based treatments that target the underlying cholestatic mechanisms of itch. He reviews the role of PPAR agonists, including newer agents studied in phase 3 trials, as well as intestinal bile acid transport (IBAT) inhibitors that may soon expand available treatment options. The video concludes with a practical framework for individualized symptom management, emphasizing that effective control of pruritus can meaningfully improve patient outcomes and overall quality of life in PBC.