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Authors: Claudia Hadlow, Medical Student, University of Notre Dame Australia, Sydney, NSW, Australia; Matthew James Verheyden, Medical Student, University of Notre Dame Australia, Sydney, NSW, Australia; Dr Tevi Wain, Consultant Dermatologist, The Skin Hospital, Westmead, NSW, Australia. DermNet NZ Editor in Chief: Adjunct A/Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. November 2019.
Aquagenic urticaria is a rare variant of chronic inducible urticaria that occurs in response to contact with water [1,2].
Less than 50 cases of aquagenic urticaria have been reported in the medical literature . There is a higher prevalence among females, with the typical age of onset during or after puberty . Most cases have occurred sporadically, but several familial cases have also been reported .
The exact pathogenesis of aquagenic urticaria is poorly understood.
Water reacts with unknown components within the skin, causing histamine release from mast cells and the formation of an urticarial rash. Triggers may include:
Aquagenic urticaria arises whatever the water temperature or its pH and is not dependent on psychogenic factors .
Skin contact with water results in symptoms within 20–30 minutes.
Rarely, the patient may also experience systemic symptoms of wheezing and shortness of breath .
Intense or prolonged itching results in excoriations that can be secondarily infected and start to ulcerate and scar.
Patients with aquagenic urticaria may suffer from psychological stress due to a fear of water.
A clinical history of urticaria in response to water exposure is suspicious of aquagenic urticaria, but the diagnosis should be confirmed by a positive water provocation test and exclusion of other types of chronic inducible urticaria.
A water provocation test can be performed to test for aquagenic urticaria using the following method:
Aquagenic urticaria must be distinguished from other forms of inducible urticaria, including :
As it is impossible to avoid water completely, treatment is aimed at relieving symptoms induced by contact with water.
The main treatment is a non-sedating, second-generation H1 antihistamine, such as cetirizine, loratadine, or fexofenadine .
Other reported treatments include:
The rate of remission of aquagenic urticaria is unknown.
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