Aquagenic pruritus

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Aquagenic pruritus
Classification and external resources
ICD-10 L29.8 (ILDS L29.83)

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[edit]

Symptomed for up to thirty-five minutes; duration of an attack is typically between ten and 120 minutes.[3] However, sensitivity varies among sufferers, and since water is always present to some extent in the air (via atmospheric humidity), those with greater sensitivity who live in moister regions will be symptomatic almost constantly, while perspiration can cause frequent symptoms even in the driest climates.

Diagnosis[edit]

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. Since pruritus is a symptom of many serious diseases, it is important to rule out other causes before making a final diagnosis.

Etymology[edit]

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

Pathogenesis[edit]

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[edit]

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 anti-pruritic lotions or creams, utilizing phototherapy, or the application of heat or cold packs to the skin after water contact.[4][7] Paradoxically, hot baths or showers help many patients, possibly due to the fact that heat causes mast cells in the skin to release their supply of histamine and to remain depleted for up to 24 hours afterward.[8] However, it is not clear that the itching associated with Aquagenic Pruritis is caused by histamine; other neurotransmitters, such as substance P, may be involved.

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.

Various studies have shown that Naltrexone, hydrocortisone or propranolol may relieve itching for some people.[7][9][10]

See also[edit]

Notes[edit]

  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. 
  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. ^ Steinman, Howard K.; Greaves, Malcolm W. (1985). "Aquagenic pruritus". Journal of the American Academy of Dermatology 13 (1): 91–6. doi:10.1016/S0190-9622(85)70149-1. PMID 2411768. 
  4. ^ 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. 
  5. ^ Lotti, T.; Steinman, H. K.; Greaves, M. W.; Fabbri, P.; Brunetti, L.; Panconesi, E. (1986). "Increased Cutaneous Fibrinolytic Activity in Aquagenic Pruritus". International Journal of Dermatology 25 (8): 508–10. doi:10.1111/j.1365-4362.1986.tb00863.x. PMID 3771051. 
  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". The Journal of Allergy and Clinical Immunology 128 (5): 1113. doi:10.1016/j.jaci.2011.05.001. PMID 21616525. 
  7. ^ a b Holme, S. A.; Anstey, A. V. (2001). "Aquagenic pruritus responding to intermittent photochemotherapy". Clinical and Experimental Dermatology 26 (1): 40–1. doi:10.1046/j.1365-2230.2001.00757.x. PMID 11260176. 
  8. ^ People's Pharmacy. "Hot Water for Itches". Retrieved 25 July 2012. 
  9. ^ 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. 
  10. ^ 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". The Journal of Allergy and Clinical Immunology 128 (5): 1113. doi:10.1016/j.jaci.2011.05.001. PMID 21616525. 

References[edit]