Aquagenic Pruritus as a Presenting Symptom of Polycythemia vera

A female patient was presented because of a prickling sensation that appeared shortly after warm water contact. Examination revealed no abnormality, but water exposure was followed by pruritus without any visible skin changes. Blood and bone marrow examinations revealed abnormalities typical of polycythemia vera. Skin biopsy before and after warm water challenge showed increased numbers of mononuclear cells in the papillary dermis and epidermis particularly after water exposure. Phlebotomy was associated with prompt cessation of pruritus.