Aquagener Pruritus als Warnzeichen eines inneren Tumorleidens – eine Fallvorstellung und Literaturübersicht

Zusammenfassung

Aquagener Pruritus (AP), d. h. Jucken, Kribbeln, Brennen nach Wasserkontakt, ist ein häufiges Symptom bei Polycythaemia vera und anderen myeloproliferativen Neoplasien, kann aber auch unabhängig davon auftreten. Wie andere Formen des Pruritus schränkt AP die Lebensqualität der Betroffenen häufig ein und kann zu einem hohen Leidensdruck führen. Zur Pathogenese existieren unterschiedliche Erklärungsansätze, jedoch kein einheitliches Konzept. Passend dazu sprechen Patienten auch nur zum Teil auf vorhandene Therapien an, die überwiegend off label sind. In dieser Literaturübersicht zum AP werden beschriebene Pathomechanismen diskutiert und mögliche Therapieformen genannt. Ein verbessertes Verständnis von AP soll dazu beitragen, dieses Symptom zu erkennen und an mögliche zugrunde liegende Erkrankungen, insbesondere an ein inneres Tumorleiden, zu denken.

Abstract

Aquagenic pruritus, i. e. itching, tingling or burning after contact with water, is a frequent symptom of polycythaemia vera or other myeloproliferative neoplasia; however, it can also appear independently. As other forms of pruritus, it often limits daily life activities and can lead to high emotional distress. While different approaches regarding its pathogenesis exist, a comprehensive concept is not yet established. Accordingly, only some patients respond well to existing treatments, which are often off-label. This review of aquagenic pruritus discusses described pathogenic mechanisms and specifies possible therapeutic approaches. An improved knowledge about AP should help to recognize this symptom and consider potential underlying diseases, e. g. importantly an intern neoplasm.

Publication History

Article published online:
20 August 2020

• Literatur

• 1 Shelley W. Post-wetness (aquagenic) Pruritus. JAMA 1970; 212: 1385
• 2 Handfield-Jones SE, Hills RJ, Ive FA. et al. Aquagenic pruritus associated with juvenile xanthogranuloma. Clin Exp Dermatol 1993; 18: 253-255
• 3 McGrath JA, Greaves MW. Aquagenic pruritus and the myelodysplastic syndrome. Br J Dermatol 1990; 123: 414-415
• 4 Khalifa N, Singer CR, Black AK. Aquagenic pruritus in a patient associated with myelodysplasia and T-cell non-Hodgkin's lymphoma. J Am Acad Dermatol 2002; 46: 144-145
• 5 Heitkemper T, Hofmann T, Phan NQ. et al. Aquagenic pruritus: associated diseases and clinical pruritus characteristics. J Dtsch Dermatol Ges 2010; 8: 797-804
• 6 Moreno Caballero B, Castro Barrio M, Blanco Andrés C. Aquagenic pruritus due to use of bupropion. Aten Primaria 2002; 30: 662-663
• 7 Jiménez-Alonso J, Tercedor J, Jáimez L. et al. Antimalarial drug-induced aquagenic-type pruritus in patients with lupus. Arthritis Rheum 1998; 41: 744-745
• 8 Mendlowicz MV, Lima JL, Fontenelle LF. Aquagenic pruritus induced by clomipramine. Gen Hosp Psychiatry 2013; 35: 577.e573-574
• 9 Diehn F, Tefferi A. Pruritus in polycythaemia vera: prevalence, laboratory correlates and management. Br J Haematol 2001; 115: 619-621
• 10 Siegel FP, Tauscher J, Petrides PE. Aquagenic pruritus in polycythemia vera: characteristics and influence on quality of life in 441 patients. Am J Hematol 2013; 88: 665-669
• 11 Arber DA, Orazi A, Hasserjian R. et al. The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127: 2391-2405
• 12 Zoi K, Cross NC. Genomics of Myeloproliferative Neoplasms. J Clin Oncol 2017; 35: 947-954
• 13 Saini KS, Patnaik MM, Tefferi A. Polycythemia vera-associated pruritus and its management. Eur J Clin Invest 2010; 40: 828-834
• 14 Le Gall-Ianotto C, Brenaut E, Gouillou M. et al. Clinical characteristics of aquagenic pruritus in patients with myeloproliferative neoplasms. Br J Dermatol 2017; 176: 255-258
• 15 Jackson N, Burt D, Crocker J. et al. Skin mast cells in polycythaemia vera: relationship to the pathogenesis and treatment of pruritus. Br J Dermatol 1987; 116: 21-29
• 16 Abdel-Naser MB, Zaki MS, Mousa MH. et al. Cutaneous mononuclear cells and eosinophils are significantly increased after warm water challenge in pruritic areas of polycythemia vera. J Cutan Pathol 2007; 34: 924-929
• 17 Newton JA, Singh AK, Greaves MW. et al. Aquagenic pruritus associated with the idiopathic hypereosinophilic syndrome. Br J Dermatol 1990; 122: 103-106
• 18 Ishii T, Wang J, Zhang W. et al. Pivotal role of mast cells in pruritogenesis in patients with myeloproliferative disorders. Blood 2009; 113: 5942-5950
• 19 Wang J, Ishii T, Zhang W. et al. Involvement of mast cells by the malignant process in patients with Philadelphia chromosome negative myeloproliferative neoplasms. Leukemia 2009; 23: 1577-1586
• 20 Vannucchi AM, Antonioli E, Guglielmelli P. et al. Clinical profile of homozygous JAK2 617V>F mutation in patients with polycythemia vera or essential thrombocythemia. Blood 2007; 110: 840-846
• 21 Tefferi A, Lasho TL, Schwager SM. et al. The clinical phenotype of wild-type, heterozygous, and homozygous JAK2V617F in polycythemia vera. Cancer 2006; 106: 631-635
• 22 Pieri L, Bogani C, Guglielmelli P. et al. The JAK2V617 mutation induces constitutive activation and agonist hypersensitivity in basophils from patients with polycythemia vera. Haematologica 2009; 94: 1537-1545
• 23 Lengfelder E, Berger U, Hehlmann R. Interferon alpha in the treatment of polycythemia vera. Ann Hematol 2000; 79: 103-109
• 24 Verstovsek S. Ruxolitinib: an oral Janus kinase 1 and Janus kinase 2 inhibitor in the management of myelofibrosis. Postgrad Med 2013; 125: 128-135
• 25 Verstovsek S, Passamonti F, Rambaldi A. et al. A phase 2 study of ruxolitinib, an oral JAK1 and JAK2 Inhibitor, in patients with advanced polycythemia vera who are refractory or intolerant to hydroxyurea. Cancer 2014; 120: 513-520
• 26 Pardanani A, Tefferi A, Jamieson C. et al. A phase 2 randomized dose-ranging study of the JAK2-selective inhibitor fedratinib (SAR302503) in patients with myelofibrosis. Blood Cancer J 2015; 5: e335
• 27 Hermans MAW, Schrijver B, van Holten-Neelen CCPA. et al. The JAK1/JAK2- inhibitor ruxolitinib inhibits mast cell degranulation and cytokine release. Clin Exp Allergy 2018; 48: 1412-1420
• 28 Gilbert HS, Warner RR, Wasserman LR. A study of histamine in myeloproliferative disease. Blood 1966; 28: 795-806
• 29 Weick JK, Donovan PB, Najean Y. et al. The use of cimetidine for the treatment of pruritus in polycythemia vera. Arch Intern Med 1982; 142: 241-242
• 30 Reid CD. Pruritus preceding the development of polycythaemia vera. Lancet 1988; 2: 964
• 31 de Wolf JT, Hendriks DW, Egger RC. et al. Alpha-interferon for intractable pruritus in polycythaemia vera. Lancet 1991; 337: 241
• 32 Greaves MW, Black AK, Eady RA. et al. Aquagenic pruritus. Br Med J (Clin Res Ed) 1981; 282: 2008-2010
• 33 Bircher AJ, Meier-Ruge W. Aquagenic pruritus. Water-induced activation of acetylcholinesterase. Arch Dermatol 1988; 124: 84-89
• 34 Cao T, Yong AA, Tan KB. et al. Idiopathic aquagenic pruritus: pathogenesis and effective treatment with atenolol. Dermatol Ther 2015; 28: 118-121
• 35 Bircher AJ. Aquagenic pruritus: treatment with sodium bicarbonate and evidence for a seasonal form. J Am Acad Dermatol 1989; 21: 817
• 36 Bayoumi AH, Highet AS. Baking soda baths for aquagenic pruritus. Lancet 1986; 2: 464
• 37 Nosbaum A, Pecquet C, Bayrou O. et al. Treatment with propranolol of 6 patients with idiopathic aquagenic pruritus. J Allergy Clin Immunol 2011; 128: 1113
• 38 Haustein UF. Aquagenic pruritus. Dermatol Monatsschr 1984; 170: 654-656
• 39 Murphy B, Duffin M, Tolland J. Aquagenic pruritus successfully treated with omalizumab. Clin Exp Dermatol 2018; 43: 858-859
• 40 Koh MJ, Chong WS. Aquagenic pruritus responding to combined ultraviolet A/narrowband ultraviolet B therapy. Photodermatol Photoimmunol Photomed 2009; 25: 169-170
• 41 Xifra A, Carrascosa JM, Ferrándiz C. Narrow-band ultraviolet B in aquagenic pruritus. Br J Dermatol 2005; 153: 1233-1234
• 42 Holme SA, Anstey AV. Aquagenic pruritus responding to intermittent photochemotherapy. Clin Exp Dermatol 2001; 26: 40-41
• 43 Menagé HD, Norris PG, Hawk JL. et al. The efficacy of psoralen photochemotherapy in the treatment of aquagenic pruritus. Br J Dermatol 1993; 129: 163-165
• 44 Ehrchen J, Ständer S. Pregabalin in the treatment of chronic pruritus. J Am Acad Dermatol 2008; 58: S36-37
• 45 Shneker BF, McAuley JW. Pregabalin: a new neuromodulator with broad therapeutic indications. Ann Pharmacother 2005; 39: 2029-2037
• 46 Metze D, Reimann S, Beissert S. et al. Efficacy and safety of naltrexone, an oral opiate receptor antagonist, in the treatment of pruritus in internal and dermatological diseases. J Am Acad Dermatol 1999; 41: 533-539
• 47 Ingber S, Cohen PD. Successful treatment of refractory aquagenic pruritus with naltrexone. J Cutan Med Surg 2005; 9: 215-216
• 48 Phan NQ, Bernhard JD, Luger TA. et al. Antipruritic treatment with systemic μ-opioid receptor antagonists: a review. J Am Acad Dermatol 2010; 63: 680-688
• 49 Tefferi A, Fonseca R. Selective serotonin reuptake inhibitors are effective in the treatment of polycythemia vera-associated pruritus. Blood 2002; 99: 2627
• 50 Zylicz Z, Krajnik M, Sorge AA. et al. Paroxetine in the treatment of severe non-dermatological pruritus: a randomized, controlled trial. J Pain Symptom Manage 2003; 26: 1105-1112
• 51 Ständer S, Böckenholt B, Schürmeyer-Horst F. et al. Treatment of chronic pruritus with the selective serotonin re-uptake inhibitors paroxetine and fluvoxamine: results of an open-labelled, two-arm proof-of-concept study. Acta Derm Venereol 2009; 89: 45-51
• 52 Paller AS, Kabashima K, Bieber T. Therapeutic pipeline for atopic dermatitis: End of the drought?. J Allergy Clin Immunol 2017; 140: 633-643
• 53 Wang F, Zhao YK, Luo ZY. et al. Aquagenic cutaneous disorders. J Dtsch Dermatol Ges 2017; 15: 602-608