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Aquagenic wrinkling of the palms
Other Resources UpToDate PubMed

Aquagenic wrinkling of the palms

Contributors: Philip Eliades, Susan Burgin MD
Other Resources UpToDate PubMed

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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Last Updated:06/07/2016
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Aquagenic wrinkling of the palms
A medical illustration showing key findings of Aquagenic wrinkling of the palms : Fine scaly plaque, Macerated skin, Palms, Hx of water immersion, Soles
Clinical image of Aquagenic wrinkling of the palms - imageId=7349462. Click to open in gallery.  caption: 'Accentuated palmar wrinkling with superimposed macerated scale, immediately after a 3 minute soak in water.'
Accentuated palmar wrinkling with superimposed macerated scale, immediately after a 3 minute soak in water.
Copyright © 2024 VisualDx®. All rights reserved.