Successful treatment of refractory aquagenic pruritus with naltrexone

Aquagenic pruritus is an intense prickling sensation that develops in affected individuals immediately after contact with water at any temperature. It is most commonly associated with polycythemia rubra vera. Common but often ineffective treatments include anticholinergics and antihistamines. Other moderately successful treatments include capsaicin cream, UVB phototherapy, and sodium bicarbonate bath water.

In this case report we describe a 55-year-old female with severe itching following showers. Underlying causes were ruled out with a series of blood tests, a chest X-ray, and serum protein electrophoresis. After multiple treatment failures, her itching was relieved with naltrexone.

Endogenous opiates, like naltrexone, can modify pruritus by influencing the peripheral and central sensation of itch. It has been found to be successful in suppressing the perception of pruritus from many diverse origins including aquagenic pruritus.