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