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Aquagenic pruritus

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Aquagenic pruritus
SpecialtyDermatology Edit this on Wikidata

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.[1][2]

Presentation

Symptoms occur for up to 35 minutes; duration of an attack is typically between 10 and 120 minutes.[3] However, sensitivity varies among sufferers, and since water is always present to some extent in the air (atmospheric humidity), those with greater sensitivity who live in moister regions are symptomatic almost constantly, while perspiration can cause frequent symptoms even in the driest climates.

Pathogenesis

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

Diagnosis

No definitive medical test is known for aquagenic pruritus. Rather, the 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.

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.[7] 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.[8][9] However, the itching associated with aquagenic pruritus is not clearly 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.

Naltrexone, hydrocortisone, or propranolol may relieve itching for some people.[10][11]

In August 2018, several members of an AP Facebook support group found they have had very good results for alleviating itch from taking small doses of Beta Alanine before trigger events. Results vary per person but feedback was very positive.

Etymology

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

See also

References

Notes

  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. ^ 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. ^ 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. ^ 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. ^ Sulzberger, Marion B (1961). Dermatology: Diagnosis and Treatment (2nd ed.). Chicago: Year Book Publishers. p. 94. ISBN 0801648084. Retrieved 11 September 2018.
  10. ^ 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.
  11. ^ 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.

Further reading

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