Ann Dermatol.  2017 Jun;29(3):341-345. 10.5021/ad.2017.29.3.341.

Aquagenic Urticaria Diagnosed by the Water Provocation Test and the Results of Histopathologic Examination

• Seol JE
• Kim DH
• Park SH
• Kang JN
• Sung HS
• Kim H

• KMID: 2378537
• DOI: http://doi.org/10.5021/ad.2017.29.3.341

Abstract

An 18-year-old male visited our department complaining of recurrent episodes of an itchy rash after hand washing, showering/bathing, drinking water, and getting rain-soaked. He was diagnosed with aquagenic urticaria after a water provocation test and histopathologic examination. Five months of antihistamine treatment successfully prevented further wheal formation. Aquagenic urticaria is a very unusual form of physical urticaria caused by contact with water. It manifests as pruritic small wheals surrounded by erythema within 30 minutes of exposure. The condition can be diagnosed by a water provocation test. Systemic antihistamines are the first-line treatment, with anticholinergics, phototherapy, or barrier cream used alternatively or additionally. Four cases of aquagenic urticaria have been reported in Korea, but no histopathologic evaluation was reported in the English or Korean literature. Herein, we provide both a case report of aquagenic urticaria diagnosed by the water provocation test and histopathologic examination results for this patient.

Keyword

Urticaria

MeSH Terms

Adolescent
Cholinergic Antagonists
Drinking Water
Erythema
Exanthema
Hand Disinfection
Histamine Antagonists
Humans
Korea
Male
Phototherapy
Urticaria*
Water*
Cholinergic Antagonists
Drinking Water
Histamine Antagonists
Water

Figure

• 

  Fig. 1 Multiple small wheals with surrounding erythema were seen on the right forearm after applying a towel soaked in tap water at body temperature for 5 minutes.

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  Fig. 2 (A) Histopathologic examination revealed conspicuous interstitial dermal edema and sparse perivascular and interstitial inflammatory cell infiltration (H&E, ×40). (B) A high-powered view showed perivascular infiltrate of lymphocytes and mast cells with endothelial swelling (H&E, ×400).

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  Fig. 3 Immunohistochemistry for c-kit showed slightly increased number of mast cells around blood vessels (×200).

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