What is aquagenic pruritis?
Aquagenic pruritus or aquagenic urticaria is a rare dermatological condition characterized by severe itching or a prickling sensation associated with water contact at any temperature. It is characterized by strong itching, stinging, tingling, or burning sensations following contact with water without visible changes on the skin. The symptoms may begin immediately after contact and can last for an hour or more. It can also exert a psychological effect to the extent of abandoning bathing or developing a phobia of bathing. There is no cure for aquagenic pruritus. However, it can be controlled with the help of several treatment options available to alleviate symptoms.
What causes aquagenic pruritus?
The underlying cause of aquagenic pruritus is unknown. In some cases, it is a symptom of polycythemia vera or another underlying condition, such as drug reactions, certain cancers, hepatitis C, and lactose intolerance. Possible underlying causes of aquagenic pruritus that have been proposed include the following:
- Increased release of granules rich in inflammatory substances, such as histamine, into the body by mast cells (mast cell degranulation): Mast cells are a special type of cells that play a role in the immune system.
- Increase in the blood levels of histamine
- Exaggerated fibrinolysis in the skin: Fibrinolysis refers to the breakdown of fibrin that forms a clot.
- Release of the chemical acetylcholine, which acts as a signaling molecule between nerves, muscles, and the brain
What are aquagenic pruritus symptoms and signs?
The main symptom of aquagenic pruritus is severe itching in the parts of the body that come in contact with water. The condition generally affects the legs followed by the arms, chest, back, and abdomen. Rarely, the head, neck, face, and hips may also be affected. Aquagenic pruritus typically spares the palms, soles, and mucosa (the inner lining of the mouth and hollow organs, such as the intestine). Because aquagenic pruritus may be a symptom of other underlying conditions, such as polycythemia vera, there may be other symptoms specific to the underlying disease or condition.
How do medical professionals diagnose aquagenic pruritus?
There is no specific exam that confirms a diagnosis of aquagenic pruritus. Generally, doctors make a diagnosis by ruling out other conditions. The following criteria may help make the diagnosis:
- Severe itching (could be the only symptom), prickling, stinging, or burning that consistently develops after the skin has been in contact with water, regardless of water temperature or salinity
- Lack of visible skin manifestations
- Reaction within minutes of exposure and lasting anywhere between 10 minutes and 2 hours
- Lack of another skin disease, underlying condition, or medication to account for the reaction
What are treatments for aquagenic pruritus?
Treatment involves medication and lifestyle modifications.
- Oral medications
- Adding sodium bicarbonate to bathwater
- Different types of phototherapies (could be up to 50% effective)
- Topical creams and ointments containing corticosteroid or capsaicin
- Transcutaneous electrical nerve stimulation (TENS)
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Salami, T.A., et al. "Prevalence and characteristics of aquagenic pruritus in a young African population." BMC Dermatol 9 Apr. 17, 2009: 4. <https://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-9-4>.
United States. National Institutes of Health. "Aquagenic Pruritus." <https://rarediseases.info.nih.gov/diseases/10278/aquagenic-pruritus>.