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Genetic and Rare Diseases Information Center (GARD)

Aquagenic pruritus

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Your Question

My 5-year-old daughter has just been told she has aquagenic pruritus. It is a very stressful time for us. Our main problem is getting her dressed in the morning, the change of clothes. We were told this is very rare for a child my daughter's age. Normally it is found in adults and not children. What can you tell us about this condition?

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is aquagenic pruritus?

Aquagenic pruritus is a condition in which contact with water of any temperature causes intense itching without any visible skin changes. The symptoms may begin immediately after contact with water and can last for an hour or more.[1] The cause of aquagenic pruritus is unknown; however, familial cases have been described.[1][2] The symptoms of the condition are similar to those seen in patients with other conditions; therefore, a thorough evaluation should be performed to rule out other more serious conditions. Overall, treatment is a challenge. Antihistamines, UVB phototherapy, PUVA therapy and various medications have been tried with varying success.[1]
Last updated: 9/28/2015

What symptoms are observed in patients who have aquagenic pruritus?

Aquagenic pruritus causes intense itching in the parts of the body that come in contact with water without an associated rash. The head, palms, soles, and mucosa are usually not affected.[1]
Last updated: 9/28/2015

How is aquagenic pruritus diagnosed?

Criteria for diagnosis include [3]:
  • Severe itching, prickling, stinging, or burning that consistently develops after skin contact with water, regardless of water temperature or salinity;
  • Lack of visible skin manifestations;
  • Reaction within minutes of exposure and lasting anywhere between 10 minutes to 2 hours;
  • Lack of a other skin disease, internal condition, or medication to account for the reaction; and
  • Exclusion of all other physical urticarias, symptomatic dermographism, and polycythemia vera.
Last updated: 9/28/2015

What causes aquagenic pruritus?

The exact cause of aquagenic pruritus is unknown, but increased mast cell degranulation (release of granules rich in histamine and other compounds into the body by mast cells, a special type of cell that plays a role in the immune system), increased circulating histamine, release of acetylcholine (a chemical in the body which sends signals from nerves to muscles and between nerves in the brain), and increased skin fibrinolytic activity (activity that controls clot size by promoting the breakdown of clots) have all been named as possible causes of the condition.[1][2] In some cases, it appears to be a symptom of polycythemia vera.[1]
Last updated: 9/28/2015

What underlying conditions and medications have been linked to aquagenic pruritus?

The following list includes the names of some of the conditions and medications that have been linked to aquagenic pruritus:[1][4]

Last updated: 9/28/2015

What treatment has been attempted in patients who have aquagenic pruritus?

The underlying cause of aquagenic pruritus is not well understood which complicates the decision about what therapy might be best for treatment.[1][2][4] Various options have been tried with varying success. Antihistamines are the mainstay of treatment. Other therapies that have been tried include adding adding sodium bicarbonate to bath water, topical capsaicin, selective serotonin reuptake inhibitors, UVB phototherapy, PUVA therapy, naltrexone, propranolol, and atenolol.[1][2]  

Last updated: 9/28/2015

  • Sekar CS, Srinivas CR, Jacob S. Aquagenic pruritus: beneath water "lies".. Indian J Dermatol. 2011 Jul; 56(4):446-7. Accessed 9/28/2015.
  • Cao T, Yong AA, Tan KB, Tey HL. Idiopathic aquagenic pruritus: pathogenesis and effective treatment with atenolol.. Dermatol Ther. 2015 May-Jun; 28(3):118-21. Accessed 9/28/2015.
  • Auerbach PS. Auerbach: Wilderness Medicine, 5th ed.. Philadelphia: Mosby, An Imprint of Elsevier; 2007;
  • Heitkemper T, Hofmann T, Phan NQ, Ständer S. Aquagenic pruritus: associated diseases and clinical pruritus characteristics.. J Dtsch Dermatol Ges. 2010 Oct; 8(10):797-804. Accessed 9/28/2015.
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.