Aquagenic pruritus is a common dermatological problem with prevalence as high as 26.5% in some locations of the world. Pruritus is the major symptom manifesting as prick-like, burning or biting sensation after contact with water. Histamine from mast cells has been the main culprit responsible for the itching associated with this problem and some patients are relieved by anti-histamines when given. However, anti-histamines do not relieve symptoms of aquagenic pruritus when given to some other groups of patients; implying that other risk factors or chemical mediators outside histamine may be responsible for this problem. Recently, other associated risk factors have been enumerated from various scientific researches to be responsible for this health problem. This article reviews these other risk factors that are linked up to the pathophysiology of aquagenic pruritus and the possible pharmacological intervention adopted by various authors and researchers globally.