Aquagenic urticaria or aquagenic pruritus is a rare dermatological condition. It is characterized by strong itching, stinging, tingling or burning sensations following contact with water at any temperature 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.
Why does aquagenic urticaria occur?
The underlying cause of aquagenic urticaria is unknown. In some cases, it is a symptom of polycythemia vera or another underlying condition. Proposed, plausible underlying causes of aquagenic pruritus include
- Increased mast cell degranulation: Releasing granules rich in histamine and other compounds into the body by mast cells, a special type of cell that plays a role in allergies and priming of the immune system.
- Increased circulating histamine: A chemical responsible for reactions.
- Release of acetylcholine: A chemical in the body that sends signals from nerves to muscles and other nerves in the brain.
- Increased skin fibrinolytic activity: An activity that controls clot size by promoting the breakdown of blood clots.
What are the symptoms of aquagenic urticaria?
Aquagenic urticaria is a rare condition that can cause an itchy, painful rash. This rash commonly appears on the neck, arms and chest, but hives can appear anywhere on the body. Within minutes of being exposed to water, people with this condition can experience
- Erythema or reddening of the skin
- Burning sensations
In more severe cases, drinking water can cause symptoms, including
How is aquagenic urticaria diagnosed?
There is no specific exam that confirms a diagnosis of aquagenic pruritus. The diagnosis is generally made 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 to two hours.
- Lack of another skin disease, underlying condition or medication to account for the reaction.
How is aquagenic urticaria treated?
Treatment involves medication and lifestyle modifications.
- Oral medications
- Adding sodium bicarbonate to bath water
- Different types of phototherapies (could be up to 50 percent effective)
- Topical creams and ointments containing corticosteroid or capsaicin
- Transcutaneous electrical nerve stimulation (TENS)
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BMC Dermatology: "Prevalence and Characteristics of Aquagenic Pruritus in a Young African Population." https://bmcdermatol.biomedcentral.com/articles/10.1186/1471-5945-9-4
Journal of the American Academy of Dermatology: "Treatment of Aquagenic Pruritus with Topical Capsaicin Cream." https://www.jaad.org/article/S0190-9622(94)70022-2/fulltext