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- Title
Idiopathic aquagenic pruritus: pathogenesis and effective treatment with atenolol.
- Authors
Cao, Taige; Yong, Angeline Anning; Tan, Kong Bing; Tey, Hong Liang
- Abstract
Aquagenic pruritus ( AP) is a rare condition with unknown pathogenesis. We explored its pathogenesis through investigations of a patient and report the first case to be effectively treated with atenolol. A 36-year-old Indian female presented with idiopathic AP. Small-fiber neuropathy involving itch/pain-transmitting C-fibers appears to be pathogenetically important: compared with matched controls, our patient had increased intra-epidermal nerve fibers, raised warmth detection threshold, and marked hyperknesis to electrical stimulation. Autonomic nerve function tests and fingertips vasoconstriction response were normal, indicating integrity of other small ( Aδ and C) nerve fibers. She was initially treated with propranolol with good response, but was subsequently switched to atenolol for convenient once-a-day dosing. Symptoms were well controlled long term with no side effect experienced. Atenolol may exert its effect in AP through blockage of over-activated neuronal sodium channels. Through the investigations, we propose that the pathogenesis of idiopathic AP may involve the following: upon contact of the skin with water, yet-unknown mediator/s released stimulate dysfunctional and hyper-innervated C-nerve fibers, which may have resulted from a sodium channel defect. Atenolol may be a preferred therapeutic option compared with propanolol, in view of its convenient once-a-day dosing and better side effect profile.
- Subjects
CUTANEOUS manifestations of general diseases; DRUG efficacy; ATENOLOL; NEUROPATHY
- Publication
Dermatologic Therapy, 2015, Vol 28, Issue 3, p118
- ISSN
1396-0296
- Publication type
Article
- DOI
10.1111/dth.12194