National Center for Advancing and Translational Sciences Genetic and Rare Diseases Information Center, a program of the National Center for Advancing and Translational Sciences

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 and can last for an hour or more.[1] The cause of aquagenic pruritus is unknown; however, familial cases have been described.[1][2] It may be a symptom of polycythemia vera or another underlying condition. Overall, treatment is a challenge. Antihistamines, UVB phototherapy, PUVA therapy and various medications have been tried with varying degrees of success.[1]
Last updated: 11/10/2016
Aquagenic pruritus causes intense itching in the parts of the body that come in contact with water.[1] The legs are most frequently affected, followed by the arms, chest, back, and abdomen. More rarely, the head, neck, face and hips may be affected.[3] The palms, soles, and mucosa are usually not affected.[1] Because aquagenic pruritus may be one symptom of polycythemia vera or another condition, it is important to look for problems in other parts of the body to rule out other conditions.[3]
Last updated: 11/10/2016
The underlying cause of aquagenic pruritus is unknown. In some cases, it is a symptom of polycythemia vera or another underlying condition. Aquagenic pruritus may precede a diagnosis of polycythemia vera by several years or more.[4] Other conditions associated with aquagenic pruritus include myeloproliferative neoplasms or myelodysplastic syndromes, hypereosinophilic syndrome, and juvenile xanthogranuloma.[1][5] Lactose intolerance and hepatitis C may also induce aquagenic pruritus.[6]

Drug-induced aquagenic pruritus has been reported in patients treated with clomipramine (a tricyclic antidepressant), bupropion (prescribed for smoking cessation), and hydroxychloroquine and chloroquine (antimalarial drugs also used for rheumatoid arthritis and lupus).[7]

Possible underlying causes of aquagenic pruritus that have been proposed include:
  • 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
  • increased skin fibrinolytic activity - activity that controls clot size by promoting the breakdown of clots[1][2]
Last updated: 11/10/2016
While the underlying cause of aquagenic pruritus is unknown, there has been evidence that genetic factors may play a role in the condition. Familial cases have been reported, particularly in cases of unknown cause (i.e not associated with polycythemia vera or another condition).[6] However, to our knowledge, no gene proven to be responsible for aquagenic pruritus alone has been identified, and the risk for a family member of an affected person to develop the condition is not known.
Last updated: 11/14/2016
There is no specific exam that confirms a diagnosis of aquagenic pruritus. The diagnosis is generally made by ruling out other conditions. The following criteria may help to make the diagnosis:[3][8] 
  • Severe itching (may be the only symptom), 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 another skin disease, underlying condition, or medication to account for the reaction
  • Exclusion of all physical urticarias, symptomatic dermographism, and polycythemia vera, as well as other diseases that my have aquagenic pruritus as a symptom.
Last updated: 6/20/2016
It is difficult to find effective treatments for aquagenic pruritus because the underlying cause is poorly understood.[1][2][3] Therapies that have been attempted with varying success include:
People with questions about the management of aquagenic pruritus should speak with their doctor about available treatment options.
Last updated: 9/6/2017

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

  • ClinicalTrials.gov lists trials that are related to Aquagenic pruritus. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

    Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

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Organizations Providing General Support

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In-Depth Information

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  1. Sekar CS, Srinivas CR & Jacob S. Aquagenic pruritus: beneath water "lies". Indian J Dermatol. 2011 Jul; 56(4):446-7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179019/.
  2. 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. http://www.ncbi.nlm.nih.gov/pubmed/25640024.
  3. Heitkemper T, Hofmann T, Phan NQ, Ständer S. Aquagenic pruritus: associated diseases and clinical pruritus characteristics. J Dtsch Dermatol Ges. October, 2010; 8(10):797-804. https://www.ncbi.nlm.nih.gov/pubmed/20546386.
  4. Sara B Fazio, Gil Yosipovitch. Pruritus: Etiology and patient evaluation. UpToDate. Waltham, MA: UpToDate; October, 2016;
  5. Le Gall-Ianotto C et al. Clinical characteristics of aquagenic pruritus in patients with myeloproliferative neoplasms. Br J Dermatol. June 13, 2016;
  6. Heitkemper T, Hofmann T, Phan NQ, Ständer S. Aquagenic pruritus: associated diseases and clinical pruritus characteristics. J Dtsch Dermatol Ges. October, 2010; 8(10):797-804.
  7. Pongpairoj K, Saha M, Greaves M. Antimalarial drug-induced aquagenic pruritus. J Eur Acad Dermatol Venereol. July 16, 2016;
  8. Auerbach PS. Auerbach: Wilderness Medicine, 5th ed.. Philadelphia: Mosby, An Imprint of Elsevier; 2007;
  9. Wang F, Zhao YK, Luo ZY, Gao Q, Wu W, Sarkar R, Luo DQ. Aquagenic cutaneous disorders. J Dtsch Dermatol Ges. June, 2017; 15(6):602-608. https://www.ncbi.nlm.nih.gov/pubmed/28513988.
  10. Sara B Fazio, Gil Yosipovitch. Pruritus: Overview of management. UpToDate. Waltham, MA: UpToDate; October, 2016;
  11. Misery L. Aquadynia and Aquagenic Pruritus. Pruritus. London: Springer; 2010; 138.