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Aquagenic wrinkling of the palms
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Aquagenic wrinkling of the palms

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Contributors: Philip Eliades, Susan Burgin MD
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Synopsis

Aquagenic palmoplantar keratoderma (APPK) presents as thickened, edematous wrinkling predominantly of the palms, and sometimes also of the soles, after a few minutes of immersion in water. Wrinkling is transient and resolves within minutes to 2 hours of drying. Occlusion of the hands, with increased perspiration, may also be a precipitating factor. The skin changes may be associated with pain, pruritus, burning, or tingling.

This rare acquired condition has a higher prevalence among patients with cystic fibrosis (CF) and CF carriers. It presents most commonly in the second and third decades, and in females.

Drug-induced cases have been reported, including aspirin, celecoxib, rofecoxib, and tobramycin.

While the etiology is unclear, an increased water-binding capacity of stratum corneum due to its high salt content, or the high salt content of sweat, is a possibility. The CFTR gene, which is mutated in CF and CF carriers, encodes a chloride ion channel that governs the movement of chloride and sodium across epithelial membranes. In the skin, the mutated CFTR results in a higher concentration of sodium in the sweat.

APPK has many different names, including:
  • Aquagenic wrinkling of the palms
  • Transient reactive papulotranslucent acrokeratoderma
  • Aquagenic syringeal keratoderma
  • Transient aquagenic palmar hyperwrinkling
  • Acquired aquagenic papulotranslucent acrokeratoderma

Codes

ICD10CM:
L98.8 – Other specified disorders of the skin and subcutaneous tissue

SNOMEDCT:
238531003 – Water-induced dermatosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Hereditary papulotranslucent acrokeratoderma — Autosomal dominant condition with onset typically around puberty; lesions persist for life and are not induced by immersion in water, unlike the transient lesions of APPK.

Other inherited palmoplantar keratodermas.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 06/08/2016
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Aquagenic wrinkling of the palms
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Aquagenic wrinkling of the palms : Fine scaly plaque, Macerated skin, Palms, Hx of water immersion, Soles
Clinical image of Aquagenic wrinkling of the palms
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