Aquagenic pruritus

Aquagenic pruritus
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Aquagenic pruritus is a skin condition characterized by the development of severe, intense, prickling-like epidermal itching without observable skin lesions and evoked by contact with water. <ref name="Fitz2">,

 Fitzpatrick's Dermatology in General Medicine, 
 6th edition, 
 McGraw-Hill, 
 2003, 
  
  
 ISBN 978-0-07-138066-9,</ref><ref name="Andrews">, 
  
 Andrews' Diseases of the Skin: Clinical Dermatology, 
 10th edition, 
 Saunders, 
 2005, 
  
  
 ISBN 978-0-7216-2921-6,</ref>

Presentation

Presentation varies from person to person. Some people have discrete attacks, which can last between 10 and 120 minutes<ref>,

 Aquagenic pruritus, 
 Journal of the American Academy of Dermatology, 
 1985,
 Vol. 13(Issue: 1),
 pp. 91–6,
 DOI: 10.1016/S0190-9622(85)70149-1,
 PMID: 2411768,</ref> while others are symptomatic almost constantly due to atmospheric humidity levels and/or sweating. Itching most frequently occurs on the legs, arms, chest, back, and abdomen, though it can also occur elsewhere.<ref>

Aquagenic pruritus(link). {{{website}}}. U.S. Department of Health and Human Services.

</ref>

Itching on contact with water that also includes hives is known as Aquagenic Urticaria.

Pathogenesis

The exact mechanism of the condition is unknown. Some studies have suggested the itching occurs in response to increased fibrinolytic activity in the skin,<ref name=pmid21965864>,

 Aquagenic pruritus: Beneath water 'lies', 
 Indian Journal of Dermatology, 
 2011,
 Vol. 56(Issue: 4),
 pp. 446–7,
 DOI: 10.4103/0019-5154.84734,
 PMID: 21965864,
 PMC: 3179019,</ref><ref>, 
 Increased Cutaneous Fibrinolytic Activity in Aquagenic Pruritus, 
 International Journal of Dermatology, 
 1986,
 Vol. 25(Issue: 8),
 pp. 508–10,
 DOI: 10.1111/j.1365-4362.1986.tb00863.x,
 PMID: 3771051,</ref> inappropriate activation of the sympathetic nervous system,<ref name=pmid21616525>, 
 Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus, 
 The Journal of Allergy and Clinical Immunology, 
 2011,
 Vol. 128(Issue: 5),
 pp. 1113,
 DOI: 10.1016/j.jaci.2011.05.001,
 PMID: 21616525,</ref> or increased activity of Acetylcholinesterase.<ref>, 
 Aquagenic Pruritus: Water-Induced Activation of Acetylcholinesterase, 
 Arch. Dermatol., 
 
 Vol. 124(Issue: 1),
 pp. 84–89,
 DOI: 10.1001/archderm.1988.01670010048020,</ref><ref>, 
 Water-Induced Itching Without Cutaneous Signs: Aquagenic Pruritus, 
 Arch. Dermatol., 
 
 Vol. 122(Issue: 2),
 pp. 183–186,
 DOI: 10.1001/archderm.1986.01660140073021,</ref>

Diagnosis

No definitive medical test is known for aquagenic pruritus. Rather, diagnosis is made by excluding all other possible causes of the patient's itching, including polycythemia vera. Since pruritus is a symptom of many serious diseases, it is important to rule out other causes before making a final diagnosis.<ref>,

 Pruritus and Systemic Disease, 
 , 
 
 
 
 
 
 
 
 Full text,</ref>

Treatment

Since the cause of the condition cannot be fully avoided in all cases, treatment is usually focused on topical itch management. This can be effected by the application of antipruritic lotions or creams, using phototherapy, or the application of hot or cold packs to the skin after water contact.<ref>,

 Aquagenic pruritus responding to intermittent photochemotherapy, 
 Clinical and Experimental Dermatology, 
 2001,
 Vol. 26(Issue: 1),
 pp. 40–1,
 DOI: 10.1046/j.1365-2230.2001.00757.x,
 PMID: 11260176,</ref> Paradoxically, hot baths or showers help many patients, possibly because heat causes mast cells in the skin to release their supply of histamine and to remain depleted for up to 24 hours afterward.<ref>

People's Pharmacy. Hot Water for Itches(link). {{{website}}}.

2012-06-18.

</ref><ref>,

 Dermatology: Diagnosis and Treatment. online version, 
 2nd edition, 
 Chicago:Year Book Publishers, 
  
  
  
 ISBN 978-0801648083,</ref>

H1 and H2 blockers, such as loratadine, doxepin, or cimetidine, have historically been the first line of pharmacological treatment, but not all sufferers find relief with these medications. When antihistamines do work, loratadine seems to be the most effective for mild cases and doxepin most effective for more severe cases.

Naltrexone, hydrocortisone, or propranolol may relieve itching for some people.<ref>,

 Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone, 
 Journal of Cutaneous Medicine and Surgery, 
 2006,
 Vol. 9(Issue: 5),
 pp. 215–6,
 DOI: 10.1007/s10227-005-0144-x,
 PMID: 16502200,</ref><ref name=pmid21616525/>

Sertraline or other Selective serotonin reuptake inhibitors (SSRIs) is also a line of treatment.

Etymology

The name is derived from Latin: aquagenic, meaning water-induced, and pruritus, meaning itch.

See also

• Aquadynia
• Aquagenic urticaria
• List of cutaneous conditions
• List of allergies

References

Notes

Further reading

• ,

 Aquagenic pruritus, 
 Journal of the American Academy of Dermatology, 
 1985,
 Vol. 13(Issue: 1),
 pp. 91–6,
 DOI: 10.1016/S0190-9622(85)70149-1,
 PMID: 2411768,

Office of Rare Diseases Research. Aquagenic pruritus(link). {{{website}}}. National Institute of Health.

• ,

 Prevalence and characteristics of aquagenic pruritus in a young African population, 
 BMC Dermatology, 
 2009,
 Vol. 9,
 pp. 4,
 DOI: 10.1186/1471-5945-9-4,
 PMID: 19374742,
 PMC: 2673209,

• ,

 Aquagenic Pruritus: Two Cases That Resolved with Histamine1 and Histamine2 Antagonists, 
 Hospital Physician, 
 
 
 pp. 67–8,
 
 
 
 
 Full text,

Aquagenic Pruritus(link). {{{website}}}. Family Practice Notebook.

Boodman, Sandra G.,

 Common symptom, uncommon cause Full text, 
 Washington Post, 
  
 May 16, 2011,

• Sekine, R.,

 Anti pruritic effects of topical crotamiton, capsaicin, and a corticosteroid on pruritogen-induced scratching behavior., 
 , 
 
 Vol. 21(Issue: 3),
 pp. 201–4,

External links

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