Aquagenic urticaria with extracutaneous manifestations.

Aquagenic urticaria (AU) is a rare form of physical urticaria in which contact with water evokes hives. Extracutaneous manifestations of AU have been described but have not been controlled successfully to date. Selective serotonin reuptake inhibitors (SSRIs) have not been used previously in the treatment of AU. The aim of this study was to describe a case of AU with extracutaneous manifestations, to describe a novel treatment approach, and to review the literature on AU. Our patient presented with urticarial lesions and migraine-like headaches after contact with any type of water. A variety of prophylactic medications including antihistamines, anticholinergics, and SSRIs, were used and, ultimately, were successful in controlling the patient's symptoms. AU is a rare condition that can have extracutaneous manifestations. Multiple classes of medications, including SSRIs, may be necessary in the treatment and prophylaxis of such patients. Additional research is needed into the pathogenesis of AU.