Aquagenic Pruritus: Why Your Skin Itches After Bathing

If you are here because you experience itchy skin after taking a bath, I will be showing you all you need to know to treat and prevent it from happening. For a long time, I have had itchy skin after a bath and despite several interventions, it has remained persistent.

Since then, I have been on the quest to understudy the possible reasons why my skin itches after a bath. Using my knowledge of the skin, allergic dermatitis, and cross-reactions, I have come up with several hypotheses which I have tested on myself along the line. For example, the use of certain creams may cross-react with certain components of your bathing water to cause skin allergies even when either of them wouldn’t.

That was just one of the hypotheses I had to test, but eventually, I came up with something more definitive and effective.

Possible Causes of Itchy Skin After a Bath

Medically, there are many causes of itchy skin after taking a bath. These include allergic causes like allergic dermatitis, water contaminants, and aquagenic urticaria. However, these causes are not quite common and when present, may be associated with other signs and symptoms like wheals, asthma, running nose, fever, etc.

Itchy skin after bathing with no observable skin lesions, referred to as aquagenic pruritus has commonly been reported in Countries like Nigeria where a lot of studies have been conducted. One such study in Ekpoma, a town in Edo State, in the Southern part of the country gave a prevalence rate of 60.75% of aquagenic pruritus of the 400 respondents in the study.^[1]Otamere H.O., Akpamu U., Odiase D.E., Osarenotor E.N. 2022. Post-bath Itching in Ekpoma and Environs: A Disturbing Prevalence Rate. Afr. J. Biomed. Res. Vol. 25

Another similar was previously conducted in 2009 in the same location in Nigeria which showed a lower prevalence of 23.8%, and also cited another study showing a prevalence of 21% among dermatologic patients in Lagos, a South-Western state in Nigeria.^[2]Prevalence and characteristics of aquagenic pruritus in a young African population – PMC Dermnet also reported that as many as 25% of adult Nigerians experience aquagenic pruritus.^[3]Aquagenic Pruritus — DermNet

Important deductions from these studies highlight the following:

1. A high prevalence of aquagenic pruritus in areas with poor access to good bathing water.
2. A High prevalence in areas with poor water storage practices.

The commonest type of post-bath itching in the 2009 study was following exposure to rainwater (23%) and then cold water (19%). Among the respondents, 8.33% feel like avoiding bathing due to the itching. On the interventions taken by the respondents, 6.25% take antihistamines for the itching, 10.42% apply body cream or wear clothes immediately after bathing to relieve the itching, while the remaining 83.33% did nothing.^[4]Prevalence and characteristics of aquagenic pruritus in a young African population – PMC

I happened to have studied in Edo State, Nigeria, the same place where two of the above studies were conducted. I also started experiencing post-bath itching about the same time I relocated to the state for my University education. Several other people living in other Nigerian states have also shared similar post-bath experiences with me.

Sometimes when I travel to other places with better borehole depth and water storage, the skin itching may subside temporarily, but this has been a recurrent experience prompting me to seek a better understanding of the condition and how to prevent it, especially when I found that it is not so much is been talked about it at a global scale.

More severe variants of aquagenic pruritus have been reported in Middle Eastern and South Asian countries like Saudi Arabia, Israel, India, Northern and Western Europe, and the United States where it has been commonly linked to genetic blood disorders like polycythemia rubra vera (PRV), essential thrombocytopenia (ET), juvenile xanthogranuloma, myelodysplastic syndrome, acute leukocytoclastic vasculitis, lymphoblastic leukemia, T-cell non Hodgkins’ lymphoma, etc.

Common aquagenic pruritus in Nigeria and other areas may not be related to any of the above medical conditions due to the following: absence of obvious skin lesions, absence of haematologic evidence in the laboratory, duration of symptom lasting between few seconds to about 20 minutes, and spontaneous resolution even without any intervention.^[5]Ibid., Otamere H.O., et al., 2022.

Factors Predisposing to Post-Bath Itching

If you do not have a history or family history of allergies, or you do not react to normal clean water (as in distilled water) when it comes in contact with your skin, and you are resident in a place where water availability and/or storage are questionable, you may likely be having this form of aquagenic pruritus not related to any of the aforementioned medical conditions.

Histamine is the primary mediator of post-bath itching. However, in some people, anti-histamines do not relieve itching; implying that other risk factors or chemical mediators may be responsible for the symptom.^[6]Aquagenic Pruritus: A Review of the Pathophysiology-Beyond Histamine – Research Gate This was also in keeping with one of my hypotheses over the 8 years I have studied this condition.

1. Dry and hypersensitive skin

Skin dryness and hypersensitivity are probably the most important risk factor for aquagenic pruritus not related to systemic allergies or hematological conditions. Skin dryness increases its hypersensitivity due to more irritable nerve endings, which is why people with naturally dry skin might experience itchy skin after taking a bath than people with more oily skin.^[7]Does sensitive skin represent a skin condition or manifestations of other disorders? – PMC

Having dry skin makes your skin irritable even to wind. The nerve endings become more sensitive to minor stimuli including tiny particles of dust, salt, or calcium precipitates resting on the skin’s surface.

You may not experience the itching immediately after the bath but as the skin dries, it might begin. This explains why some people quickly apply body cream or wear clothes immediately after bathing to prevent skin itching.

Excessive scrubbing with a sponge may worsen or trigger the itching after bathing. The use of harsh soaps, creams, or perfumes may also make it worse. Cold may also increase the skin’s hypersensitivity.^[8]Prevalence and characteristics of aquagenic pruritus in a young African population – PMC

2. Water chemicals

Certain chemicals in water can trigger pruritic reactions in some people after bathing. These include water salts like calcium and magnesium salts. These are the same salts that cause water hardness which is why hard water might increase the chances of experiencing skin itching after having a bath.

Other chemicals from the storage tank like iron deposits may also account for post-bath itching. After an initial bath with these chemicals, they may remain on the skin surface where they may initiate some immune sensitization, leading to an allergic reaction in the form of itching on a second exposure to the same chemical for which the sensitization occurred. This is the pathogenesis of allergic reactions.

3. Water pH

Acidic water can also increase your skin’s sensitivity. This may explain why bathing with rainwater may predispose more to aquagenic pruritus compared to other sources of water.^[9]Prevalence and characteristics of aquagenic pruritus in a young African population – PMC

The skin’s outer layer, the stratum corneum, also referred to as the acid mantle, maintains a naturally acid pH between 4.7 and 5.7. This helps to maintain its barrier function against environmental irritants and allergens. Bathing with more acidic water (water with a lower pH) can disrupt the skin’s pH balance, weakening the barrier, and making the skin more susceptible to dryness and irritation.^[10]About Skin and Skin’s pH – Eucerin

Acidic water may also strip off the skin’s natural oils during a bath which can lead to dryness and accentuate skin sensitivity.

Also, exposure of the skin to unbalanced pH levels can stimulate the nerve endings, leading to histamine release or skin hypersensitivity.

3. Soap constituents

The constituents of your bathing soap may be too harsh for your skin which might predispose you to skin itching, especially if you already have sensitive skin. Soaps with pH closer to the normal skin pH range are referred to as pH-balanced or neutral soaps and may be preferred in cases of hypersensitive skin or aquagenic pruritus.

4. Sponge and towel impurities

Sponge and towels have also been implicated as potential causes of itchy skin after a bath. This is not because these materials are in themselves allergenic but it may be due to deposition of impurities on these materials over time.

Salts from hard water may deposit on the fibers of sponges and towels and may be transferred back to the skin on subsequent use. In sufficient amounts, these impurities can trigger significant itching after bathing that may qualify for a description of aquagenic pruritus.

To prevent this, it is important you wash your sponge and towel regularly with hot water and detergent/soap. The hot water will help to dissolve the salts or other chemical impurities back into the solution, helping remove them from the fibers and preventing skin itching following the reuse of those bathing materials.

Treatment of Aquagenic Pruritis (Itchy Skin After Bathing)

Based on the mechanisms discussed above, several treatments have been proposed for the treatment of aquagenic pruritus.

1. Bicarbonate emollients
2. Ultraviolet B phototherapy and oral antihistamines
3. Baking Soda bath
4. Capsaicin cream
5. Naltrexone
6. Psorialem Ultraviolet A (PUVA) and Astemizole
7. Atenolol
8. UV A/narrow band/UV B therapy
9. Tight fitting clothing
10. PUVA and Capsaicin
11. Alcohol rub
12. Propanolol
13. Psorialein photochemotherapy.

The above mechanisms mostly include stabilizing skin pH, soothing and heating effect of UV light, and blocking nerve endings.

How to Prevent Skin Itching After a Bath

Of course, preventing skin itching is better than treating it after it has occurred. This is because of the discomfort from the itchiness and the fact that some of the treatment options above may not be available when it occurs.

Here are some specific ways to prevent aquagenic pruritus and have more peaceful baths afterward.

1. Identify your skin dryness/sensitivity

First, you need to identify if your skin is dry or if you have sensitive skin. To do this, pinch your skin with two fingers and gently rub the skin between your fingers. Check if it feels dry, soft, or oily. After that, scratch the skin in a straight line; the presence of a white dusty crust indicates that your skin is dry.

If you have sensitive skin, you might have experienced other kinds of skin reactions to other substances especially when your skin is dry. There might also be a family history of a similar condition. Adequate use of moisturizing lotions/creams would help keep your skin moisturized and reduce its sensitivity.

2. Take shorter and milder baths

Many Nigerians believe that scrubbing the skin judiciously with a strong sponge and spending longer time in the bathroom makes their skin cleaner, which explains why itching after a bath is fairly commonly experienced here. On the contrary, you can still achieve clean skin using a soft foam sponge or without sponging occasionally while preventing inflammatory reactions from hard sponging.

Also, consider bathing with milder soaps and for shorter durations to avoid washing off too much protective sebum (oil) from your skin.

3. Soften your water

We have seen how hard water can cause skin itching after bathing. Calcium and magnesium salts, as well as other chemical impurities like iron, can trigger skin itching after a bath. Thus, softening your bathing water with bicarbonate or baking soda can be helpful.

4. Check your water pH

If you notice aquagenic pruritus after moving to a new environment, a change in water pH might be the culprit. You might need to check your domestic water pH for acidity. You can check it using a pH strip, litmus paper, or a pH meter device which you can get at a cheap price.

It is best to bathe with neutral or pH-balanced water, but if you detect acidic water, adding baking soda or sodium bicarbonate to it can help neutralize the acidity. You can also neutralize your water pH directly in the source tank.

However, at a large scale, you might need the services of a water purifying company to install a water filter system that can help remove impurities as well as automatically inject small amounts of pH balancing and chlorination chemicals into it.

5. Wash your water tank

For causes related to water hardness or the presence of impurities, washing your water storage tank can help prevent itching after having a bath. Several tank cleaning specialists recommend cleaning your water tank at least once a year, or at least four times a year if your borehole pumps impurities due to the type of earth or the depth of drilling.

Washing your water tank can reduce your likelihood of experiencing itchy skin after taking your baths.

6. Wash your sponge and towel regularly

If your bathing water naturally has skin-irritating chemicals, washing your bathing materials regularly can help prevent these solutes from depositing on them. For example, repeated use of a sponge or towel can lead to the deposition of calcium or magnesium salts, and when used to scrub or wipe the body after a bath, may leave some of those particles on the skin which can trigger skin itching.

When washing your sponge and towel, boil water and soak the sponge or the towel in the hot water. Apply some amount of detergent to the towel and leave for some time. For your sponge, you don’t need to add any more soap or detergent, as the soap remnant in it will be sufficient to clean it.

7. Boil your bathing water

Boiling your bathing water before bathing can help prevent itching after having a bath. This aim of this boiling is not to kill microbes because they are rarely implicated in this type of post-bath skin itching. Rather it serves two purposes: softening the water by making the hard salts dissolve, and raising the water temperature to reduce skin sensitivity.

It is important to bathe with the water while it is still warm. Most of the time, this helps prevents the skin itching after taking a bath.

If you stay long before taking your first bath of the day, boiling your water before bathing becomes very important. This is because dirts on your skin may predispose it to being more sensitive. Also, it is important to wear clothes, especially shirts, to prevent skin dryness, contamination with surrounding dust, and increased skin sensitivity.

Aquagenic Urticaria

Another similar but rarer variant of aquagenic pruritus is aquagenic urticaria (AU). Though similar, they are not exactly the same thing with aquagenic urticaria being a more severe condition.

Aquagenic urticaria is also known as water allergy because its mechanism is similar to the same way hay or pollen trigger wheals on the skin or an asthmatic attack. But in this case, it involves an allergic reaction against water, irrespective of its purity, pH, or temperature.

It was first described by Shelley and Rawnsley in 1964 as the development of wheals on a patient’s skin within 30 minutes of contact with water of any source or temperature, and lasting between 30 minutes to 2 hours after cessation of exposure to water. This was also reported to develop more on the trunk and upper extremities.^[11]Acquagenic Urticaria – Science Direct

Throughout medical literature, only about 50 cases of aquagenic urticaria has been reported making it extremely rare. The pathogenesis involves some interaction between water molecules and sebum from the skin’s sebaceous glands, which leads to degranulation of perifollicular mast cells and subsequent release of histamine. Recall, histamine is the primary chemical mediator of allergies.

Unlike aquagenic pruritus, the presence of wheals on the skin and a persistent reaction to water of any pH or temperature makes aquagenic urticaria stand out. Also, AU may be life-threatening and may be associated with other manifestations like angioedema. However, it responds better to antihistamines than in the case of aquagenic pruritus.

Other treatments of aquagenic urticaria includes topical barrier gels with water-repelling characteristics, and treatment with Omalizumab, a monoclonal antibody.

Other Causes of Skin Itching

Skin itching can occur from various other causes. We already established a link between skin itching and blood disorders like polycythemia rubra vera, lymphomas, etc. Other causes of skin itching which may or may not be related to a bath include the following:

• Chlorine rash: Due to excess chlorine in water. Lesions may form, which may later blister and rupture.
• Cold urticaria: A form of skin allergy resulting from excessive expousre to cold or cold water.
• Chronic liver failure/renal failure: Chronica organ failure can lead to the accumulation of pruritogenic metabolites on the skin, including ammonia, urea, and creatinine.
• Drug reactions: Some drugs may cause skin itching as a side effect. Examples include sulphonamides and chloroquine. This may be associated or aggravated by contact with water.
• Skin parasites like scabies, bugs, and mites.

General hygiene to prevent skin itching after a bath

Sometimes, skin itching may be related to poor personal hygiene practices. In this case, it can be prevented by keeping these general hygiene practices as follows:

1. Take your baths regularly, at least 2-3 times daily, especially if you live in the tropics.
2. Wash your towel and sponge regularly as described in the body of this post.
3. Avoid keeping your towel damp for a long time.
4. Ensure to bathe with clean, non-hard, and uncontaminated water.
5. Avoid sharing towels and sponges as much as possible.

Final words

Having itching skin after taking a bath can be such a horrible experience, which is why I have put together this entire post to help you find solution to the issue. As someone that has experienced this aquagenic pruritus, or skin itching after a bath, I did my personal observations as well as looked at some research to find a working solution to anyone experiencing this condition.

I hope this post has helped you largely. If you need more clarification in any aspect, let me know in the comment section below.

Stay well!

Subscribe to Our Blog

If you enjoy our articles, subscribe to get our latest posts delivered right to your inbox.

Subscribe Now

We respect your privacy. No spam, ever.

Leave this field empty if you're human: