Pruritus is frequently encountered in primary care and is often attributed to benign dermatologic or allergic conditions. Aquagenic pruritus (AP), however, is a recognized early manifestation of polycythemia vera (PV). Awareness of AP is important because timely interpretation of subtle symptoms and routine laboratory abnormalities can enable rapid referral and help prevent thrombotic complications.A 46-year-old woman presented with a six-month history of intense itching after hot showers, accompanied by tingling in the left hand. Previous antihistamine and topical steroid treatments had not been effective. Physical examination was unremarkable. Initial evaluation revealed hemoglobin 17.3 g/dL, hematocrit 52.4%, platelets 442×10⁹/L. She was referred to the hematology department for further evaluation. Bone marrow biopsy confirmed hypercellularity with increased megakaryocytes and a normal myeloid-to-erythroid ratio. Further testing showed JAK2 V617F positivity.  These findings supported a myeloproliferative neoplasm. Although the initial presentation could suggest dermatologic, neurologic, or allergic conditions these possibilities were reconsidered in light of the markedly abnormal hematologic findings. The combination of AP, elevated hemoglobin/hematocrit, thrombocytosis, low EPO, and JAK2 positivity made alternative diagnoses less likely. She received aspirin and consecutive phlebotomies, with improvement in pruritus and paresthesia.Large cohort studies report that AP affects most patients and often begins several years before diagnosis; however, only about 15% of patients undergo hematologic evaluation during this period, contributing to diagnostic delay. This highlights the valuable contribution of primary care to the timely identification of polycythemia vera, particularly in younger patients, where the diagnosis is less expected. PV most commonly presents around age 60, and this case represents a younger presentation than described in the literature.Persistent aquagenic pruritus is a finding that should prompt consideration in primary care settings. Recognizing accompanying abnormalities can help reduce diagnostic delays and improve  outcomes.This case demonstrates how integrating nonspecific symptoms with routine laboratory findings can support clinical reasoning in primary care.This case shows that nonspecific symptoms like pruritus, when interpreted in conjunction with complete blood count findings,  provide diagnostic clues and support the earlier identification of conditions like polycythemia vera in primary care.