We report our experience in the treatment of two patients with aquagenic pruritus of the elderly and two patients with aquagenic pruritus. Our findings confirm previous reports by others indicating that aquagenic pruritus is not one homogenous entity but rather is composed of two similar but distinct entities, each of which responds to a different treatment. Patients with aquagenic pruritus were helped by adding sodium bicarbonate to the bath water while patients with aquagenic pruritus of the elderly responded to emollients. It is suggested that aquagenic pruritus and aquagenic pruritus of the elderly are two similar but distinct entities. Separating these two entities provides the key to successful treatment, because each of them responds to a different treatment without crossover. This report is only the second report indicating the effectiveness of sodium bicarbonate baths in patients with aquagenic pruritus. It is clear that further examples are needed to confirm these findings.