by David Wallace
For many people living with polycythemia vera (PV) and other myeloproliferative neoplasms, stepping into a warm shower can trigger an unbearable sensation that has nothing to do with the water temperature. Aquagenic pruritus (intense itching that occurs after contact with water) remains one of the most frustrating symptoms patients face, affecting nearly two-thirds of those diagnosed with PV. Unlike typical itching, there’s no rash to treat, no hives to soothe, just distressing discomfort that can last for hours and significantly impact quality of life and mental health.
A recent breakthrough case study published in Case Reports in Dermatology offers a promising possibility: beta-alanine (β-alanine), a supplement commonly found in fitness and vitamin stores, might provide meaningful relief for PV-related itching. While the patient in this study didn’t have an MPN diagnosis, the underlying mechanisms are relevant for those struggling with similar symptoms.
Understanding Aquagenic Pruritus in Polycythemia Vera (PV)
Aquagenic pruritus strikes when skin meets water, whether from bathing, swimming, or even heavy sweating. This severe skin condition is characterized by an intense, prickling-like sensation that occurs regardless of water temperature or type, and it presents without any visible skin lesions, making diagnosis challenging.
For PV patients, this symptom often appears years before their official diagnosis, acting as an early warning sign of a potential health problem. The intensity can be overwhelming, with some patients describing it as feeling like their skin is on fire or crawling with insects.
Traditional treatments have yielded mixed results at best. High-dose antihistamines, topical steroids, and even switching to cold showers provide little relief for many. This condition leaves patients searching for alternatives, often feeling frustrated by the lack of effective options.
The Beta-Alanine Breakthrough: Case Study Results
The case involves a 33-year-old man who endured aquagenic pruritus for over five years. Despite extensive testing, including JAK2 mutation screening and bone marrow biopsy, doctors found no underlying blood disorders. His experience mirrors that of many patients who suffer from this condition without clear answers.
After years of failed treatments (including high-dose antihistamines, the biologic medication omalizumab, steroid creams, and various moisturizers), he discovered an unexpected solution. Taking 4 to 5 grams of beta-alanine dissolved in water about 10 minutes before showering dramatically reduced his symptoms.
The results were dramatic:
- Itching intensity plummeted from a debilitating 10 out of 10 to a very manageable 1 out of 10
- Significant relief persisted for a minimum of 20 weeks
- Only mild skin tingling occurred as a side effect
- Treatment efficacy was maintained at 20-week follow-up
Mechanism of Action
Beta-alanine is thought to prevent aquagenic itching by acting on the skin’s itch nerves directly. This amino acid targets a specific receptor on certain nerve fibers called MrgprD receptors, which are involved in non-histamine itch responses. By binding to these receptors, beta-alanine essentially pre-activates and desensitizes the nerves that normally react strongly when skin comes into contact with water.
Think of it like turning down the volume on an overly sensitive microphone: beta-alanine gives those itch-sensing nerves a small, controlled “buzz” beforehand so they are not as reactive when the real trigger, water, arrives. As a result, the usual cascade of itch signals is dampened before it can spike.
Human case reports and small studies have observed this effect in action. Patients with aquagenic pruritus, including those with polycythemia vera, who took beta-alanine before bathing have reported little to no itching afterward compared to intense itching without it. This suggests that beta-alanine may not just mask symptoms, it may address the root cause at the nerve level. By calming the skin’s overactive itch pathways ahead of time, beta-alanine can help prevent the intense “itch attack” from ever fully igniting.
Patient Testimonials: Beta-Alanine for PV-Related Itching
While little clinical data exists on beta-alanine for polycythemia vera (PV)-related pruritus, anecdotal reports from patients are beginning to show impressive results. Here are firsthand accounts from individuals with PV who found unexpected relief:
“I’ve lived with PV for almost 15 years. The itching after showers was unbearable, I’d scratch for an hour, losing my mind. One scoop of beta-alanine in water changed everything. I’m happy again. I don’t fear showers anymore.”
— Robert
“I’m 73 and was diagnosed with PV about 4 years ago. My biggest issue wasn’t treatment, it was the maddening itch after showers, especially on my back and arms. I dreaded stepping into the water. Then I tried beta-alanine, and for the first time in years, no itching. I couldn’t believe it. I did feel a brief tingling in my face right after taking it, but it passed quickly and the results were worth it. It truly felt like a miracle.”
— Frank“Beta-Alanine saved my sanity. After years of severe itching, I found relief by adding a small dose to water before showers. It took some time to find the right dose, but it works.”
— Rhonda, PV patient
These testimonials highlight how beta-alanine has enabled patients to engage in water-related activities without the discomfort that previously made simple daily routines unbearable.
What This Means for PV Patients
While this case study involved someone without an MPN diagnosis, the neurological pathways involved in aquagenic pruritus may be similar across different patient populations. For PV/MPN patients who have exhausted conventional treatments, beta-alanine represents a potentially valuable addition to their symptom management toolkit.
The supplement’s accessibility is another advantage:
- Available over-the-counter at most supplement stores
- Affordable, making it accessible regardless of healthcare coverage
- No insurance approval or prescription monitoring required
Before You Try Beta-Alanine for PV-Related Itching
If you’re considering beta-alanine to help with aquagenic pruritus, it’s advisable to discuss it with your healthcare provider. However, keep in mind that most hematologists, and perhaps some MPN specialists, may not be familiar with this off-label approach. Bringing a printed copy of this article to your appointment may help guide the conversation.
When choosing a supplement, go for one that lists only pure beta-alanine, no unnecessary fillers or blends. Start with a lower dose (about 2 grams daily) to gauge how your body reacts. If tolerated, you can gradually increase to the 4–5 gram range used in published reports. It may take a little time to find the right dose adjustment that works for you.
Expect paresthesia, a tingling or prickly feeling that’s common with beta-alanine. It’s usually harmless and often fades as your body adjusts to regular use.
Managing Expectations
Beta-alanine isn’t a cure for aquagenic pruritus, and it may not work for everyone. However, for patients who have struggled with limited treatment options, it offers hope for meaningful symptom improvement. The rapid relief reported in case studies, often within minutes, suggests patients can quickly determine if this approach will help their PV-related itching.
The safety profile appears favorable based on current evidence, though long-term studies in this specific population are lacking. As with any new treatment approach, staying in close communication with your healthcare team ensures that any changes in your condition are properly monitored and managed.
Research Gaps and Clinical Implications
Right now, there are no studies that specifically show how well beta-alanine works for itching in patients with secondary aquagenic pruritus, particularly those with blood cancers like polycythemia vera. While aquagenic pruritus might occur in the context of an underlying MPN, often preceding the diagnosis by years, most cases of aquagenic pruritus are not linked to blood disorders.
However, emerging research offers intriguing details about the biological mechanisms that may make beta-alanine effective across different patient populations. Studies have identified a potential role of mast cells and basophils in aquagenic pruritus development. Notably, researchers have reported more hyperresponsive circulating basophils in patients with MPN who also have aquagenic pruritus, compared to those without this symptom. This finding suggests that the inflammatory pathways involved in MPN-related itching may respond similarly to beta-alanine’s mechanism of action.
The current case study evidence supports beta-alanine as an efficient and safe treatment option for aquagenic pruritus. While more research is specifically needed for MPN patients, the underlying neurological and inflammatory pathways appear to be similar enough that PV patients may experience comparable benefits to those reported in primary aquagenic pruritus cases.
The Bottom Line: Hope for PV Patients
This new research establishes the foundation for further investigations into the potential management of aquagenic pruritus, especially in patients with PV or any other MPN (MF, ET). While awaiting more comprehensive studies, preliminary evidence suggests that this affordable supplement might be an effective strategy to beat itching in polycythemia vera.
For the nearly two-thirds of PV patients who struggle with aquagenic pruritus, beta-alanine offers renewed hope after years of limited treatment options. The combination of accessibility, affordability, favorable safety profile, and promising early results makes it a conversation worth having with your doctor, especially when conventional treatments have proven inadequate.
As our understanding of beta-alanine’s effects expands, patients and healthcare professionals should approach its use with cautious optimism, considering individual responses and maintaining close communication with healthcare teams to ensure proper monitoring of this complex condition.
References:
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Primary Aquagenic Pruritus Successfully Treated by β-Alanine. Case Reports in Dermatology. Volume 17, Issue 1, 2025.
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Burden of Aquagenic Pruritus in Polycythaemia Vera. Lelonek E, Matusiak Ł, Wróbel T, Szepietowski JC. Acta Derm Venereol. 2018;98(5):496-500.
- Aquagenic pruritus as a presenting symptom of polycythemia vera. Acta Haematol. 1993;90(1):47-9. PMID: 8358102.
- Beta-alanine as a Potential Treatment for Aquagenic Pruritus: An Online Social Media-based Survey Study. PMID: 40657651.
