4th June 2025

Medical management

The management of polycythaemia depends on the underlying cause; there is no cure for PV and so management focuses on symptomatic relief and the prevention of complications. For PV patients under 60 years and at low-risk of thrombosis, phlebotomy and low-dose aspirin are first-line treatments. For PV patients over 60 years and/or at high-risk of thrombosis, cytoreductive therapy (such as with hydroxycarbamide) and low-dose aspirin are first-line. As a result, the reduction in circulating red cell volume should improve some of the skin manifestations of polycythaemia.

For aquagenic pruritus several different treatments have been suggested, such as antihistamines, aspirin, SSRIs and JAK2 inhibitors in refractory cases. 

For erythromelalgia secondary to polycythaemia, aspirin is the first-line treatment.