Aquagenic pruritus: Difference between revisions

Aquagenic pruritus
Aquagenic pruritus
Specialty	Dermatology

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Aquagenic pruritus is a skin condition characterized by the development of severe, intense, prickling-like epidermal itching that is without observable skin lesions and that is evoked by contact with water.^[1]^[2]

Presentation

Symptoms may be felt immediately after contact with water or humid air or may be delayed for up to fifteen minutes; duration of an attack is typically between ten and 120 minutes.^[3]

Diagnosis

There is no definitive medical test for Aquagenic Pruritus. Rather, the diagnosis is made by excluding all other possible causes of the patient's itching. Because pruritus is a symptom of many serious diseases, it is important to rule out other causes before making a definitive diagnosis.

Etymology

The name is derived from Latin: Aquagenic, meaning water-induced, and Pruritus, meaning itch.

Pathogenesis

The exact mechanism of the condition is unknown, though some studies have suggested that the itching occurs in response to increased fibrinolytic activity in the skin.^[4]^[5] Later studies indicate that inappropriate activation of the sympathetic nervous system may play a part.^[6]

Treatment

Since the cause of the condition cannot be fully avoided (water is always present to some extent in the air), treatment is focused on topical itch management. This can be effected by the application of anti-pruritic lotions or creams, utilizing phototherapy, adjusting the temperature of bathing water, or the application of heat or cold packs to the skin after bathing. ^[4]^[7]

Since pruritus is sometimes caused by the release of histamine, H1 and H2 blockers such as loratadine, doxepin or cimetidine have usually been the first line of treatment, but clinical response varies. When antihistamines do work, Loratadine seems to be the most effective for mild cases and doxepin most effective for more severe cases. Where antihistamines fail to improve symptoms, Naltrexone, hydrocortisone or propranololmay be effective.^[8]^[9]^[7]

Notes

^ Freedberg, Irwin M.; Eisen, Arthur Z.; Wolff, Klaus; Austen, K. Frank; Goldsmith, Lowell A.; Katz, Stephen I., eds. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill. p. 401. ISBN 978-0-07-138066-9.
^ James, William Daniel; Berger, Timothy G.; Elston, Dirk M. (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. p. 56. ISBN 978-0-7216-2921-6.
^ . doi:10.1016/S0190-9622(85)70149-1. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
^ ^a ^b Sekar, Cshanmuga; Jacob, Sheja; Srinivas, CR (2011). "Aquagenic pruritus: Beneath water 'lies'". Indian Journal of Dermatology. 56 (4): 446–7. doi:10.4103/0019-5154.84734. PMC 3179019. PMID 21965864.{{cite journal}}: CS1 maint: unflagged free DOI (link)
^ . doi:10.1111/j.1365-4362.1986.tb00863.x. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
^ Nosbaum, Audrey; Pecquet, Catherine; Bayrou, Olivier; Amsler, Emmanuelle; Nicolas, Jean F.; Bérard, Frédéric; Francès, Camille (2011). "Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus". Journal of Allergy and Clinical Immunology. 128 (5): 1113. doi:10.1016/j.jaci.2011.05.001.
^ ^a ^b . doi:10.1046/j.1365-2230.2001.00757.x. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
^ Ingber, Sarah; Cohen, Paul D. (2006). "Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone". Journal of Cutaneous Medicine and Surgery. 9 (5): 215–6. doi:10.1007/s10227-005-0144-x. PMID 16502200.
^ . doi:10.1016/j.jaci.2011.05.001. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

References

. doi:10.1016/S0190-9622(85)70149-1. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)
Office of Rare Diseases Research. "Aquagenic pruritus". National Institute of Health. Retrieved 18 April 2012.
. doi:10.1186/1471-5945-9-4. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)CS1 maint: unflagged free DOI (link)
Santoso, Ivan; Santoso-Pham, Julia C. (1999). "Aquagenic Pruritus: Two Cases That Resolved with Histamine₁ and Histamine₂ Antagonists" (PDF). Hospital Physician: 67–8. {{cite journal}}: Unknown parameter |month= ignored (help)
"Aquagenic Pruritus". Family Practice Notebook. Retrieved 18 April 2012.
Boodman, Sandra G. (May 16, 2011). "Common symptom, uncommon cause". Washington Post. Retrieved 03 Jul 2012. {{cite news}}: Check date values in: |accessdate= (help)

External links

[Fitz2-1] Freedberg, Irwin M.; Eisen, Arthur Z.; Wolff, Klaus; Austen, K. Frank; Goldsmith, Lowell A.; Katz, Stephen I., eds. (2003). Fitzpatrick's Dermatology in General Medicine (6th ed.). McGraw-Hill. p. 401. ISBN 978-0-07-138066-9.

[Andrews-2] James, William Daniel; Berger, Timothy G.; Elston, Dirk M. (2005). Andrews' Diseases of the Skin: Clinical Dermatology (10th ed.). Saunders. p. 56. ISBN 978-0-7216-2921-6.

[3] . doi:10.1016/S0190-9622(85)70149-1. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

[pmid21965864-4] Sekar, Cshanmuga; Jacob, Sheja; Srinivas, CR (2011). "Aquagenic pruritus: Beneath water 'lies'". Indian Journal of Dermatology. 56 (4): 446–7. doi:10.4103/0019-5154.84734. PMC 3179019. PMID 21965864.{{cite journal}}: CS1 maint: unflagged free DOI (link)

[5] . doi:10.1111/j.1365-4362.1986.tb00863.x. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

[6] Nosbaum, Audrey; Pecquet, Catherine; Bayrou, Olivier; Amsler, Emmanuelle; Nicolas, Jean F.; Bérard, Frédéric; Francès, Camille (2011). "Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus". Journal of Allergy and Clinical Immunology. 128 (5): 1113. doi:10.1016/j.jaci.2011.05.001.

[pmid11260176-7] . doi:10.1046/j.1365-2230.2001.00757.x. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

[pmid16502200-8] Ingber, Sarah; Cohen, Paul D. (2006). "Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone". Journal of Cutaneous Medicine and Surgery. 9 (5): 215–6. doi:10.1007/s10227-005-0144-x. PMID 16502200.

[9] . doi:10.1016/j.jaci.2011.05.001. {{cite journal}}: Cite journal requires |journal= (help); Missing or empty |title= (help)

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@@ Line 16: / Line 16: @@
 ==Presentation==
-Symptoms may be felt immediately after contact with water or humid air or may be delayed for up to fifteen minutes; duration of an attack is typically between ten and 120 minutes.<ref>{{cite journal |pmid=2411768 |year=1985 |last1=Steinman |first1=HK |last2=Greaves |first2=MW |title=Aquagenic pruritus |volume=13 |issue=1 |pages=91–6 |journal=Journal of the American Academy of Dermatology |doi=10.1016/S0190-9622(85)70149-1}}</ref>
+Symptoms may be felt immediately after contact with water or humid air or may be delayed for up to fifteen minutes; duration of an attack is typically between ten and 120 minutes.<ref>{{cite journal |doi=10.1016/S0190-9622(85)70149-1}}</ref>
 ==Diagnosis==
@@ Line 25: / Line 25: @@
 ==Pathogenesis==
-The exact mechanism of the condition is unknown, though some studies have suggested that the itching occurs in response to increased [[fibrinolytic]] activity in the skin.<ref name=pmid21965864>{{cite journal |doi=10.4103/0019-5154.84734 |title=Aquagenic pruritus: Beneath water 'lies' |year=2011 |last1=Sekar |first1=Cshanmuga |last2=Jacob |first2=Sheja |last3=Srinivas |first3=CR |journal=Indian Journal of Dermatology |volume=56 |issue=4 |pages=446–7 |pmid=21965864 |pmc=3179019}}</ref><ref>{{cite journal |pmid=3771051 |year=1986 |last1=Lotti |first1=T |last2=Steinman |first2=HK |last3=Greaves |first3=MW |last4=Fabbri |first4=P |last5=Brunetti |first5=L |last6=Panconesi |first6=E |title=Increased cutaneous fibrinolytic activity in aquagenic pruritus |volume=25 |issue=8 |pages=508–10 |journal=International journal of dermatology |doi=10.1111/j.1365-4362.1986.tb00863.x}}</ref> Later studies indicate that inappropriate activation of the sympathetic nervous system may play a part.<ref>{{cite journal |doi=10.1016/j.jaci.2011.05.001 |title=Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus |year=2011 |last1=Nosbaum |first1=Audrey |last2=Pecquet |first2=Catherine |last3=Bayrou |first3=Olivier |last4=Amsler |first4=Emmanuelle |last5=Nicolas |first5=Jean F. |last6=Bérard |first6=Frédéric |last7=Francès |first7=Camille |journal=Journal of Allergy and Clinical Immunology |volume=128 |issue=5 |pages=1113}}</ref>
+The exact mechanism of the condition is unknown, though some studies have suggested that the itching occurs in response to increased [[fibrinolytic]] activity in the skin.<ref name=pmid21965864>{{cite journal |doi=10.4103/0019-5154.84734 |title=Aquagenic pruritus: Beneath water 'lies' |year=2011 |last1=Sekar |first1=Cshanmuga |last2=Jacob |first2=Sheja |last3=Srinivas |first3=CR |journal=Indian Journal of Dermatology |volume=56 |issue=4 |pages=446–7 |pmid=21965864 |pmc=3179019}}</ref><ref>{{cite journal |doi=10.1111/j.1365-4362.1986.tb00863.x}}</ref> Later studies indicate that inappropriate activation of the sympathetic nervous system may play a part.<ref>{{cite journal |doi=10.1016/j.jaci.2011.05.001 |title=Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus |year=2011 |last1=Nosbaum |first1=Audrey |last2=Pecquet |first2=Catherine |last3=Bayrou |first3=Olivier |last4=Amsler |first4=Emmanuelle |last5=Nicolas |first5=Jean F. |last6=Bérard |first6=Frédéric |last7=Francès |first7=Camille |journal=Journal of Allergy and Clinical Immunology |volume=128 |issue=5 |pages=1113}}</ref>
 ==Treatment==
-Since the cause of the condition cannot be fully avoided (water is always present to some extent in the air), treatment is focused on topical itch management. This can be effected by the application of anti-pruritic lotions or creams, utilizing [[phototherapy]], adjusting the temperature of bathing water, or the application of heat or cold packs to the skin after bathing. <ref name=pmid21965864/><ref name=pmid11260176>{{cite journal |pmid=11260176 |year=2001 |last1=Holme |first1=SA |last2=Anstey |first2=AV |title=Aquagenic pruritus responding to intermittent photochemotherapy |volume=26 |issue=1 |pages=40–1 |journal=Clinical and experimental dermatology |doi=10.1046/j.1365-2230.2001.00757.x}}</ref>
+Since the cause of the condition cannot be fully avoided (water is always present to some extent in the air), treatment is focused on topical itch management. This can be effected by the application of anti-pruritic lotions or creams, utilizing [[phototherapy]], adjusting the temperature of bathing water, or the application of heat or cold packs to the skin after bathing. <ref name=pmid21965864/><ref name=pmid11260176>{{cite journal |doi=10.1046/j.1365-2230.2001.00757.x}}</ref>
-Since pruritus is sometimes caused by the release of [[histamine]], H1 and H2 blockers such as [[loratadine]], [[doxepin]] or [[cimetidine]] have usually been the first line of treatment, but clinical response varies. When antihistamines do work, Loratadine seems to be the most effective for mild cases and doxepin most effective for more severe cases. Where antihistamines fail to improve symptoms, [[Naltrexone]], [[hydrocortisone]] or [[propranolol]]may be effective.<ref name="pmid16502200">{{cite journal |doi=10.1007/s10227-005-0144-x |title=Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone |year=2006 |last1=Ingber |first1=Sarah |last2=Cohen |first2=Paul D. |journal=Journal of Cutaneous Medicine and Surgery |volume=9 |issue=5 |pages=215–6 |pmid=16502200}}</ref><ref>{{cite journal |pmid=21616525 |year=2011 |last1=Nosbaum |first1=A |last2=Pecquet |first2=C |last3=Bayrou |first3=O |last4=Amsler |first4=E |last5=Nicolas |first5=JF |last6=Bérard |first6=F |last7=Francès |first7=C |title=Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus |volume=128 |issue=5 |pages=1113 |doi=10.1016/j.jaci.2011.05.001 |journal=The Journal of allergy and clinical immunology}}</ref><ref name=pmid11260176/>
+Since pruritus is sometimes caused by the release of [[histamine]], H1 and H2 blockers such as [[loratadine]], [[doxepin]] or [[cimetidine]] have usually been the first line of treatment, but clinical response varies. When antihistamines do work, Loratadine seems to be the most effective for mild cases and doxepin most effective for more severe cases. Where antihistamines fail to improve symptoms, [[Naltrexone]], [[hydrocortisone]] or [[propranolol]]may be effective.<ref name="pmid16502200">{{cite journal |doi=10.1007/s10227-005-0144-x |title=Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone |year=2006 |last1=Ingber |first1=Sarah |last2=Cohen |first2=Paul D. |journal=Journal of Cutaneous Medicine and Surgery |volume=9 |issue=5 |pages=215–6 |pmid=16502200}}</ref><ref>{{cite journal |doi=10.1016/j.jaci.2011.05.001}}</ref><ref name=pmid11260176/>
 == See also ==
@@ Line 40: / Line 40: @@
 == Notes ==
-{{ibid}}
 {{reflist}}
 == References ==
-*{{cite journal | author = Steinman H, Greaves M | title = Aquagenic pruritus | journal = J Am Acad Dermatol | volume = 13 | issue = 1 | pages = 91–6 | year = 1985 | pmid = 2411768 | doi = 10.1016/S0190-9622(85)70149-1}}
+*{{cite journal |doi=10.1016/S0190-9622(85)70149-1}}
+*{{cite web |author=Office of Rare Diseases Research |publisher=National Institute of Health |title=Aquagenic pruritus |url=http://rarediseases.info.nih.gov/GARD/Condition/10278/Aquagenic_pruritus.aspx |accessdate=18 April 2012}}
+*{{cite journal |doi=10.1186/1471-5945-9-4}}
-*{{cite web|last=Offices of Rare Diseases Research|first=National Institute of Health|title=Aquagenic pruritus|url=http://rarediseases.info.nih.gov/GARD/Condition/10278/Aquagenic_pruritus.aspx|accessdate=18 April 2012}}
+*{{cite journal |first1=Ivan |last1=Santoso |first2=Julia C. |last2=Santoso-Pham |month=September |year=1999 |title=Aquagenic Pruritus: Two Cases That Resolved with Histamine<sub>1</sub> and Histamine<sub>2</sub> Antagonists |url=http://www.turner-white.com/pdf/hp_sep99_pruritus.pdf |journal=Hospital Physician |pages=67–8}}
-*{{cite web|last=Salam|first=Ta, et. al.|title=Prevalence and characteristics of aquagenic pruritus in a young African population|url=http://www.biomedcentral.com/1471-5945/9/4|publisher=BMC Dermatology|accessdate=18 April 2012}}
+*{{cite web |title=Aquagenic Pruritus |url=http://www.fpnotebook.com/Sports/DER/AqgncPrts.htm |publisher=Family Practice Notebook |accessdate=18 April 2012}}
+*{{cite news |last=Boodman |first=Sandra G. |date=May 16, 2011 |title=Common symptom, uncommon cause |url=http://www.washingtonpost.com/national/health/common-symptom-uncommon-cause/2011/04/22/AFHzQA5G_story.html |work=Washington Post |accessdate=03 Jul 2012}}
-*{{cite web|last=Santoso|first=Ivan, et. al.|title=Aquagenic Pruritus: Two Cases That Resolves With Histamine-1 and Histamine-2 Antagonists|url=http://www.turner-white.com/pdf/hp_sep99_pruritus.pdf|publisher=Hospital Physician|accessdate=18 April 2012}}
-*{{cite web|title=Aquagenic Pruritus|url=http://www.fpnotebook.com/Sports/DER/AqgncPrts.htm|publisher=Family Practice Notebook|accessdate=18 April 2012}}
-*{{cite journal|author=Boodman, Sandra G.|title=Common symptom, uncommon cause|url=http://www.washingtonpost.com/national/health/common-symptom-uncommon-cause/2011/04/22/AFHzQA5G_story.html|journal=Washington Post|accessdate=03 Jul 2012}}
 ==External links==
-[http://health.groups.yahoo.com/group/aquagenicskin/ Aquagenic Pruritus support group on Yahoo]
+*[http://health.groups.yahoo.com/group/aquagenicskin/ Aquagenic Pruritus support group on Yahoo]
+*[http://www.experienceproject.com/groups/Have-Aquagenic-Pruritus/89261/ Aquagenic Pruritus support group on Experience Project]
-[http://www.experienceproject.com/groups/Have-Aquagenic-Pruritus/89261/ Aquagenic Pruritus support group on Experience Project]

v t e Dermatitis and eczema
Atopic dermatitis	Prurigo gestationis Sweat allergy
Seborrheic dermatitis	Pityriasis simplex capillitii Cradle cap
Contact dermatitis (allergic, irritant)	plants: Urushiol-induced contact dermatitis African blackwood dermatitis Tulip fingers other: Abietic acid dermatitis Diaper rash Airbag dermatitis Baboon syndrome Contact stomatitis Metal allergy Protein contact dermatitis
Eczema	Autoimmune estrogen dermatitis Autoimmune progesterone dermatitis Breast eczema Ear eczema Eyelid dermatitis Topical steroid withdrawal Hand eczema Dyshidrosis Hyperkeratotic hand dermatitis Autosensitization dermatitis/Id reaction Candidid Dermatophytid Molluscum dermatitis Circumostomy eczema Juvenile plantar dermatosis Nummular eczema Nutritional deficiency eczema Sulzberger–Garbe syndrome Xerotic eczema
Pruritus/Itch/ Prurigo	Lichen simplex chronicus/Prurigo nodularis by location: Pruritus ani Pruritus scroti Pruritus vulvae Scalp pruritus Drug-induced pruritus Hydroxyethyl starch-induced pruritus Senile pruritus Aquagenic pruritus Aquadynia Adult blaschkitis due to liver disease Biliary pruritus Cholestatic pruritus Prion pruritus Prurigo pigmentosa Prurigo simplex Puncta pruritica Uremic pruritus
Other	substances taken internally: Bromoderma Fixed drug reaction Nummular dermatitis Pityriasis alba Papuloerythroderma of Ofuji