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Authors: Dr Adam Dedat, Trainee General Practitioner and Dr Ian Coulson, Consultant Dermatologist, East Lancashire NHS Trust, UK. Copy edited by Gus Mitchell. April 2022
Aquagenic pruritus is a severe prickling-like sensation/itch which is triggered by the presence of water at any temperature and of any type (such as rainwater, seawater, bath/tap water, and even sweat) on the skin. It is a variant of inducible pruritus.
Aquagenic pruritus can vary in severity between a mild nuisance to unbearably debilitating. It can be so severe as to result in a fear of bathing and water aversion. During the period of itching, the skin will appear normal; it is distinguishable from aquagenic urticaria, where itch is accompanied by wheals.
The cause of aquagenic pruritus is unknown, however, studies have shown that mast cell degranulation, localised release of acetylcholine, and increased cutaneous fibrinolytic activity all play a role.
Severe aquagenic pruritus with intense itching may be associated with and be a harbinger of haematological disease and malignancy, the best know associations being with:
Blood disorders may manifest several years after the onset of itch, and annual evaluation and haematology testing is recommended.
Clinical characteristics include:
The diagnosis is made on the basis of the presence of characteristic symptoms following water exposure, with the absence of visible skin changes during the period of itch.
Treatment options include:
Aquagenic pruritus can be an ongoing and a persistant problem, particularly when associated with blood disorders.
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