Clinical Question, please help...

[vanelo]

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Hey all!

I am currently an OPH PGY-1, loyal SDN'er. This is the first time I use this forum for this type of thread.

I'll tell you MY case. Since 2 years, I have had very occassional and unfrequent episodes of SEVERE itching over my legs after I take a bath. Every time, I've believed the episodes were caused by the soap, so now I use only hypoallergenic soaps. As I said, these episodes were sporadic, taking place about once every 4-5 months, lasted about 10 minutes of an itching sensation I could not bear.

About 2 weeks ago, it happened to me again. Since I am kind of "used" to them every couple of months I just scratched myself and let it be.

What REALLYworries me is that I had a very very bad episode yesterday. I have to lay in the floor and scratch myself very hard, since I can hardly do anything else when it starts. It gets to a point where I am almost tearing my skin off because it's so frustrating. Since I had that bad experince yesterday, and I counldn't change the soap, I just bathed myself with only water so it wouldn't happen. Guess what?

Today I had another episode, even worst than the ones before that included not only my legs as it had done previously, but my arms too and lasted about 15 minutes! I can't bear the thought of not knowing why this happens to me. I just know I am the allergic type (chronic nasal allergies, allergic to ASA, previously asthamatic, etc)

I have tried to look information over the web and I know it's kind of hard to believe I am the first case ever to be reported to be allegic to water! I am not a hypochondriac and this is definetly not psychological or psychosomatic as many people may think.

My Physical: No fever, no rash, no lymphadenopathy. Completely unremarkable except for what I've mentioned before.

I don't pretend any of you diagnosing me but believe me I'm desperate to at least have a clue of what this may be. I would gladly appreciate any of you Dermatologists out there pointing me in the right direction.

Thanks

 

[ForSkin]

Hey all!

I am currently an OPH PGY-1, loyal SDN'er. This is the first time I use this forum for this type of thread.

I'll tell you MY case. Since 2 years, I have had very occassional and unfrequent episodes of SEVERE itching over my legs after I take a bath. Every time, I've believed the episodes were caused by the soap, so now I use only hypoallergenic soaps. As I said, these episodes were sporadic, taking place about once every 4-5 months, lasted about 10 minutes of an itching sensation I could not bear.

About 2 weeks ago, it happened to me again. Since I am kind of "used" to them every couple of months I just scratched myself and let it be.

What REALLYworries me is that I had a very very bad episode yesterday. I have to lay in the floor and scratch myself very hard, since I can hardly do anything else when it starts. It gets to a point where I am almost tearing my skin off because it's so frustrating. Since I had that bad experince yesterday, and I counldn't change the soap, I just bathed myself with only water so it wouldn't happen. Guess what?

Today I had another episode, even worst than the ones before that included not only my legs as it had done previously, but my arms too and lasted about 15 minutes! I can't bear the thought of not knowing why this happens to me. I just know I am the allergic type (chronic nasal allergies, allergic to ASA, previously asthamatic, etc)

I have tried to look information over the web and I know it's kind of hard to believe I am the first case ever to be reported to be allegic to water! I am not a hypochondriac and this is definetly not psychological or psychosomatic as many people may think.

My Physical: No fever, no rash, no lymphadenopathy. Completely unremarkable except for what I've mentioned before.

I don't pretend any of you diagnosing me but believe me I'm desperate to at least have a clue of what this may be. I would gladly appreciate any of you Dermatologists out there pointing me in the right direction.

Thanks

just a wild guess ... you might have a physical urticaria, either to heat or, much more rarely, to water. switch to cold showers or try a benadryl before warm ones to see if that helps. heat urticarias are histamine-based, but water urticarias are not and may be helped by capsaicin. of course, you should go see a dermatologist ... blah, blah, blah.

 

[readydoc]

Hey Polycythemia may sometimes present as itching after a warm shower. Get a complete blood count done

 

[vanelo]

Thanks for the input, I'll order myself a CBC then!

Any other differentials?

 

[Florian]

In this paper the current knowledge on water-induced pruritus is reviewed. To the present, three forms, namely aquagenic pruritus (AP), aquagenic pruritus of the elderly (APE) and water-related itching in polycythemia rubra vera (PRV), have been recognized. Despite clinical similarities it appears that the pathophysiology is different in the three forms. The currently most effective treatment for AP is addition of sodium bicarbonate to the water, control of xerosis with emollients for APE and aspirin for water-induced itching in PRV.

Treatment options also include topical corticosteroids, systemic H1- or H2-receptor antagonists, UVB phototherapy and IFN-alpha i.m.

 

[peppersgrl]

My sister has aquagenic urticaria....truly a horrible condition. Cholinergic and pressure urticarias run in my family and i suffer from them also. I have tried all the antihistamines alone but what seems to work well for me is the combo of singulair and an antihistamine together. of course, it works better when i take them daily. one of our other residents also suffered from some of the mechanical urticarias and once she was started on singulair and an antihistamine, she seemed to do ok.

but i totally agree with checking a cbc for polycythemia b/c that would be a condition that would be treated differently (obviously).

one other thing...if you truly have aquagenic urticaria (not just pruritis), you need to keep an epipen around and if u go swimming, you should always swim with someone in case you go into anaphylactic shock.

Good Luck and keep us updated!