Aquagenic Pruritus

What is aquagenic pruritus?

Aquagenic pruritus is a skin condition that causes your skin to itch when water touches it. It does not cause visible symptoms such as hives or rashes. People with this condition experience symptoms within minutes of exposure to water. The itching and burning sensations can last for an hour or longer.

Any temperature or type of water can cause this condition. People usually experience symptoms when bathing or showering. The psychological effect can cause them to stop bathing.

How does aquagenic pruritus occur?

Healthcare providers are not sure how this condition develops. It seems that it may be linked to abnormal cellular processes in the skin, nervous system or immune system.

Sometimes, more than one person in a family has this condition. But researchers haven’t identified a specific gene linked to the condition that can be passed from parents to their children.

Where does aquagenic pruritus occur?

It can occur almost anywhere on your body. The most common location is your legs, followed by your arms, chest and back.

It usually doesn’t affect the palms of your hands, soles of your feet or mucus membranes like the insides of your mouth, nose and ears. This means people can drink water without symptoms.

How common is aquagenic pruritus?

There are no accurate estimates of how often it occurs.

What causes aquagenic pruritus?

It can occur without an apparent cause (idiopathic) or as a symptom of another condition.

Nearly two-thirds of people with polycythemia vera have aquagenic pruritus. This is a potentially serious condition where your body makes too many red blood cells. Aquagenic pruritus may also occur with other medical conditions like:

• Chronic urticaria or chronic hives.
• Hypereosinophilic syndrome, a group of blood disorders that result from having too many eosinophils, a type of white blood cell.
• Myelodysplastic syndromes and other blood cancers.

Can medications cause aquagenic pruritus?

Although rare, medications can cause this condition, including:

• Bupropion and clomipramine, medications for depression.
• Hydroxychloroquine and chloroquine, drugs that prevent and treat malaria.

What are the symptoms of aquagenic pruritus?

Symptoms include severe itching, stinging, tingling or burning sensations after water gets on your skin. Many people also experience emotional stress.

How is aquagenic pruritus diagnosed?

Providers diagnose it based on your symptoms and when they occur. Your provider will also ask about your family history and perform a physical exam.

Is there a cure for aquagenic pruritus?

There is no cure but treatment can help you control the condition. If a medication causes it, symptoms usually go away when you stop taking the medication. If your healthcare team can identify an underlying medical condition that’s related to your symptoms, treating this condition can help reverse or reduce your symptoms.

How is aquagenic pruritus treated?

Treatment can be challenging. Providers use a wide range of treatments, including medications, procedures and natural remedies. You may need to try different treatments to find one that works for you.

Providers use a variety of medications and procedures to help relieve itching and pain. These can include:

• Antihistamines, allergy medications.
• Analgesics, pain relievers.
• Transcutaneous electrical nerve stimulation (TENS), a procedure used to reduce pain.
• Ultraviolet therapy (phototherapy), a procedure that treats some skin conditions.

Other medications that provide relief in some patients include:

• Beta blockers, medications used to treat high blood pressure.
• Cholestyramine, a medication that prevents the absorption of bile acid.
• Naltrexone, a drug used to treat alcohol and opioid use disorders.
• Selective serotonin reuptake inhibitors, a class of antidepressant medications.

Natural remedies for controlling symptoms include:

• Baking soda, sodium bicarbonate in your bath water can raise the pH of the water and may help lessen symptoms.
• Capsaicin, creams containing this active ingredient in chili peppers can help relieve itching and pain after contact with water.
• Beta-alanine, it’s not clear how these supplements help, but some people have reported relief when using them.
• Baby oil, coating your skin with it before taking a shower can help give your skin a protective barrier.

How can I prevent aquagenic pruritus?

Because providers are not clear what causes it, there are no strategies to prevent this condition.

What is the prognosis for people with aquagenic pruritus?

Your outlook depends on your response to the available treatment options. Your provider will work with you to find an effective treatment. If you have aquagenic pruritus associated with another condition, your outlook may depend on that condition.

How can I live with aquagenic pruritus?

If left untreated, this condition can decrease your quality of life. Treatment may be challenging. Yet, we strongly advise working with your provider to get better control over your symptoms so you’ll be able to comfortably shower and swim. After you achieve good symptom control, continue to follow your provider’s instructions and attend routine appointments.

A note from Cleveland Clinic

Aquagenic pruritus can make bathing and swimming an itchy, painful experience. Your provider can help you find a treatment that will ease your symptoms and allow you to continue your normal activities. If you have aquagenic pruritus that is associated with another condition, your provider will provide close, ongoing care to help you manage your health.