Aquagenic Palmoplantar Keratoderma

  • Onset in 2nd decade
  • Females more than males
  • Palmar aquagenic wrinkling in ~50% of cases of cystic fibrosis and ~10–25% of heterozygous carriers of cystic fibrosis transmembrane conductance regulator gene mutations
  • Reports of autosomal dominant / recessive inheritance patterns
  • Reported onset with use of cyclooxygenase-2 inhibitors

  • Unknown

  • Rapid onset of thickening and white / clear “pebbly” changes in palmar area after water contact
  • Resolution when water exposure removed
  • May have burning pain

Dermoscopy:

  • Dilated acrosyringeal ostia

 

Pathology:

  • Normal or dilated eccrine ostia, limited stratum corneum hyperkeratosis

Differential:

  • Hereditary papulotranslucent acrokeratoderma
  • Bothnia type of diffuse non-epidermolytic palmoplantar keratoderma

  • Botulinum toxin injection 
  • Topical 20% aluminum chloride hexahydrate and urea cream