The itching in aquagenic pruritus or bathing itch can be so intense and prickly that some of the sufferers develop aversion to bathing. Aquagenic pruritus is very chronic and resistant to treatment in most patients. To compound the matter, it does not respond to conventional anti-itch medications, like antihistamines and getting rid of aquagenic pruritus is really a challenge.
The itching usually starts immediately or within minutes of contact with water. In some persons, itching is induced by sudden drop in temperature, as entering a cold room or freezer compartments, in humid weather conditions. Contact with rain water induces more itching than normal tap water in most affected individuals. Itching may continue for hours after bathing.
Because of the chronic nature, treatment resistance and lack of skin rashes, patients with the aquagenic pruritus are most often labeled as psychoneurotic and prescribed antidepressant or anxiolytic medications.
Causes of Aquagenic Pruritus
The exact cause is not known why some people develop allergy to the water. Various chemical mediators have been found in the affected skin, like histamine and acetyl choline. Though mast cells degranulate and secrete histamine as a response to contact with water, it is evident, from the ineffectiveness of antihistamines, that histamine is not the primary mediator in aquagenic pruritus (as opposed to aquagenic urticaria, where the histamine induced wheals appear along with itching on exposure to water).
Diseases Associated with Aquagenic Pruritus
In addition to the unknown (idiopathic) origin of aquagenic pruritus, more seriously, there are some diseases in which the bathing itch may be the presenting symptom.
- Polycythemia vera, itching on exposure to water and sudden changes in temperatures may be the premonitory symptom in polycythemia vera.
- Metastatic carcinoma of cervix in women
- Hypereosinophilic syndrome
- Juvenile xanthogranuloma
- Myelodysplastic syndrome.
How to Get Rid of Aquagenic Pruritus
The most effective treatment of the aquagenic pruritus involves the desensitization of the skin through phototherapy. The following are a few tips on treating the bathing itch:
- Though most antihistamines are ineffective in aquagenic pruritus, a combination of long acting antihistamines like Cetrizine 10 mg and short acting antihistamines like Cyproheptadine 4 mg is useful in reducing the intensity of the itching in the water induced pruritus.
- Before bath, apply an oil based emollient lotion to your body, face, and limbs. This will reduce water coming in direct contact with the skin and will reduce the intensity of itching.
- If itching occurs, in addition to the antihistamine combination above, apply Capsaicin cream to the skin, immediately after the bath.
- Avoid forcible showers, hot water or prolonged stay in the pool. Use the pool and bath water when it is at body temperature. Those who have cold urticaria or itching following cold exposure will feel better with warm water bath and increased itching following contact with cold water.
- Use only cotton dresses, cotton sheets and cotton quilts on your bed. Any contact with synthetic dresses, woolen blankets etc will increase the tendency to itch.
- Avoid alcohol, coffee, hot, spicy, fried fast foods. Drink lots of fresh fruit juices (except mango) and eat more vegetables.
- If the itching is intense and intractable, phototherapy with Psoralen-UVA or filtered UVB will provide excellent results in most patients. These are available in most dermatologists’ offices.
Thus, though very resistant to conventional treatments, patients with aquagenic pruritus can enjoy the occasional plunge with proper precautions and medications. It has also to be borne in mind that all itching after contact with water is not aquagenic pruritus, it could be contact dermatitis to the soap, solvents in the water, brush etc. If wheals are present, it is called aquagenic urticaria.
Reference
- Pruritus, in Rook’s Textbook of Dermatology, 7th Edition, 2004
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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