Aquagenic wrinkling of the palms
Aquagenic wrinkling of the palms (AWP) is a rare condition that often occurs in patients with cystic fibrosis. It may also occur in carriers of the cystic fibrosis gene. It has previously been called transient reactive papulotranslucent acrokeratoderma, aquagenic keratoderma, aquagenic syringeal acrokeratoderma, and simply wrinkling of the skin.
What is the cause of AWP?
The cause of AWP is unknown but relates to sweating. It may be caused by a salt imbalance in the skin cells, which results in increased water retention within these cells and increased transepidermal water loss. Some cases have been related to different medications, such as non-steroidal anti-inflammatories and some antibiotics.
What are the clinical features?
AWP resembles the exaggerated wrinkling of the palms which is caused by spending too long in a bath or pool. Clinically, it is characterised by the appearance or worsening of a palmar eruption, following brief exposure to water. It takes longer to appear in mutation carriers (about 7 minutes) than in patients with cystic fibrosis (2-3 minutes). The palmar eruption is comprised of small, white or translucent papules that coalesce into plaques. The feet are unaffected. Patients may report an uncomfortable tight or burning sensation during an eruption. In most cases the palmar skin returns to normal within a few hours of exposure to water, however, in some cases the eruption can persist for longer periods.
How is the diagnosis made?
The diagnosis of AWP is usually made on the basis of the clinical history and physical findings. The palmar eruption can usually be readily demonstrated by exposing the hands to water. In some cases a biopsy may be taken to confirm the diagnosis.
Some patients have had relief with an antiperspirant such as 20% Aluminium Chloride Hexahydrate (Drysol®, Driclor®) applied to the palms at night.
| Left hand has been immersed in water for 1 minute
Images supplied by Dr Delwyn Dyall-Smith.
- Park L, Khani C, Tamburro J. Aquagenic wrinkling of the palms and the potential role for genetic testing. Pediatr Dermatol. 2012 May-Jun;29(3):237-42. doi: 10.1111/j.1525-1470.2011.01609.x. Epub 2011 Nov 2. Review. PubMed PMID: 22044449.
- Tolland JP, Boyle J, Hall V, McKenna KE, Elborn JS. Aquagenic wrinkling of the palms in an adult cystic fibrosis population. Dermatology. 2010;221(4):326-30. doi: 10.1159/000319754. Epub 2010 Sep 25. PubMed PMID: 20881360.
- Gild R, Clay CD, Morey S. Aquagenic wrinkling of the palms in cystic fibrosis and the cystic fibrosis carrier state: a case–control study. Br J Dermatol. 2010 Nov;163(5):1082-4. doi: 10.1111/j.1365-2133.2010.09914.x. PubMed PMID: 20560957.
- Garçon-Michel N, Roguedas-Contios AM, Rault G, Le Bihan J, Ramel S, Revert K, Dirou A, Misery L. Frequency of aquagenic palmoplantar keratoderma in cystic fibrosis: a new sign of cystic fibrosis? Br J Dermatol. 2010 Jul;163(1):162-6. doi: 10.1111/j.1365-2133.2010.09764.x. Epub 2010 Mar 10. PubMed PMID: 20302572.
- Berk DR, Ciliberto HM, Sweet SC, Ferkol TW, Bayliss SJ. Aquagenic wrinkling of the palms in cystic fibrosis: comparison with controls and genotype-phenotype correlations. Arch Dermatol. 2009 Nov;145(11):1296-9. doi: 10.1001/archdermatol.2009.260. PubMed PMID: 19917960.
- Kabashima K, Shimauchi T, Kobayashi M, Fukamachi S, Kawakami C, Ogata M, Kabashima R, Mori T, Ota T, Fukushima S, Hara-Chikuma M, Tokura Y. Aberrant aquaporin 5 expression in the sweat gland in aquagenic wrinkling of the palms. J Am Acad Dermatol. 2008 Aug;59(2 Suppl 1):S28-32. doi: 10.1016/j.jaad.2008.04.023. PubMed PMID: 18625374.
On DermNet NZ:
Books about skin diseases:
See the DermNet NZ bookstore