Aquagenic wrinkling of the palms

Author: Dr Mathew Ludgate, Dermatology Registrar, Greenlane Hospital, Auckland, New Zealand, 2005.

Introduction

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 aquagenic wrinkling of the palms?

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 of aquagenic wrinkling of the palms?

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 of aquagenic wrinkling of the palms 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.

What is the treatment for aquagenic wrinkling of the palms?

Some patients have had relief with an antiperspirant such as 20% Aluminium Chloride Hexahydrate (Drysol®, Driclor®) applied to the palms at night. Bathing in salt water may also prove effective.

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