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It may sound unusual, but some people develop itchy rashes after getting into a shower or taking a bath. Although medical literature says that this condition, called aquagenic urticaria is a rare disorder, it may be because only a few people report their symptoms to their doctors.

Aquagenic urticaria is a form of physical urticaria (wheal) that is triggered by some external irritant. Wheals (also called hives) are superficial skin swellings surrounded by redness that lasts from a few minutes to several hours.

They are usually very itchy or may have a burning sensation. There are various physical factors that may trigger an urticarial skin reaction, such as sweat, cold weather, sun exposure or physical touch, but aquagenic urticaria usually develops after one gets into contact with water, which may be hot or cold, fresh, salty or chlorinated.

Aquagenic urticaria affects children but tends to be more common among women than men. Other factors that may increase one's risk of developing aquagenic urticaria include genetic factors, lactose intolerance, HIV infection, and other forms of urticaria and atopy. Symptoms usually occur after bathing, swimming, touching water, or walking in the rain, but in some cases, skin break outs may occur even when sweating or emitting tears. In rare cases, wheezing, difficulty swallowing, or respiratory distress may occur after drinking water. Other people experience aquagenic pruritus, or itchiness after contact with water, but without the skin wheals.

The diagnosis of aquagenic urticaria may be done by placing water directly on the skin or using a soaked paper towel. The skin is then checked for a reaction in the next 10 to 15 minutes. Since this condition frequently accompanies other forms of physical urticaraia, other tests may be done to check for other conditions.

Treatment

Although aquagenic urticaria may be uncomfortable, it is not a serious condition. There is no cure, but most treatments aim to reduce symptoms. These include:

  • Oral antihistamines, such as cetirizine, loratidine, hydroxyzine, and cyproheptadine may help reduce the effects of aquagenic urticaria. Therapeutic responses may vary from patient to patient. The benefits of topical antihistamine have not been found to be greater than those taken orally.
  • Psoralen photochemotherapy (PUVA) therapy has been to help manage the symptoms of aquagenic urticaria, but maintenance therapy is needed for remission.
  • Ultraviolet radiation may be used with antihistamine treatment to help reduce skin lesions and outbreaks, but this therapy may cause thickening of the skin. Ultraviolet therapy may also help limit mast cell response and promote immunosuppression, which can help reduce these reactions.
  • Treatments for HIV (human immunodeficiency virus) such as Stanazolol have been found to help reduce symptoms of aquagenic urticaria.
  • Capsaicin (Zostrix) cream may be applied to the skin to lessen pain caused by aquagenic urticaria.
  • Barrier or emulsion creams may be applied to protect the skin from water exposure when swimming or walking in the rain.
  • Topical corticosteroids have not been proven to be effective.
  • Epinephrine shots may be needed by patients who suffer from severe bouts of acute urticaria.

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