A.A. Yong, H.L. Tey
We present an interesting case of a 36 year-old Indian
female who was initially diagnosed with aquagenic urticaria
and treated with oral antihistamines with limited
response. Further history subsequently revealed that there
were no visible skin changes despite an intense itching on
direct contact with water. A diagnosis of Idiopathic
Aquagenic Pruritus (IAP) was then made as this was not
associated with any underlying illnesses. Oral propanolol
was subsequently instituted at 10mg bd with a dramatic
improvement of symptoms within one month of treatment.
Aquagenic pruritus is the onset of pruritus after contact with
water with no visible skin changes. It is often misdiagnosed as aquagenic urticaria and in nearly 70% of patients there is
no identiﬁable triggering disease (IAP). There is a higher
proportion of women with IAP and the selection of an appropriate
therapy is not straightforward as the mechanism of
cutaneous induction of aqugenic pruritus is not well understood.
Treatment at the moment is unsatisfactory as many
patients only achieve a modest treatment response with
various medications reported in the literature. Propanolol
has been reported in a couple of publications to have some
effect in patients with aqugenic pruritus,and proved in our case to be a suitable and efﬁcacious drug for the treatment of IAP in the absence of contraindications.