Acquired aquagenic papulotranslucent acrokeratoderma

Abstract

We report the case of a healthy 16-year-old male with progressively increasing brown macules arranged in a zosteriform pattern on the left abdomen and back. The lesion appeared at the age of 15 and has been enlarged since then. He had no history of any preceding eruption or injury to the area. He had no evidence of internal diseases. His family had no history of skin abnormalities. He was not taking any medications. Physical examination revealed linear, cribriform, brown macular pigmentation arranged in a zosteriform pattern on the left abdomen and back ( fig. 1). All macules were uniformly tan. Laboratory studies, including complete blood cell count, liver and renal function tests and serum electrolyte, had negative results. A skin boipsy specimen from the abdomen revealed increased pigmentation within the basal keratinocytes. There were a few dermal melanophages. No nevus cells were present ( fig. 2). Fontana-Masson stain showed an increase in melanin in the basal keratinocytes. The diagnosis of progressive cribriform and zosteriform hyperpigmentation -the late onset linear and whorled nevoid hypermelanosis was made. No treatments were given.Progressive cribriform and zosteriform hyperpigmentation was first described by Rower and colleagues in 1978. 1 The following criteria were suggested: (1) uniformly tan cribriform macular pigmentation in a zosteriform distribution; (2) a histologic pattern that consisted of a mild increase in melanin pigment in the basal cell layer and complete absence of nevus cells; (3) no history of rash, injury, or inflammation to suggest postinflammatory hyperpigmentation; (4) onset well after birth with gradual extension -age at onset was in the second decade of life in every case; and (5) lack of other associated cutaneous or internal abnormalities. 1 Linear and whorled nevoid hypermelanosis was first described by Kalter and colleagues in 1988. 2 It is characterized by swirls and streaks of macular hyperpigmentation along the lines of Blaschko. It usually appears early during the first year of life. In some patients, the lesions are quite stable, while in others they spread but then stabilize by the age of 2-3. The linear hyperpigmentation tends to persist indefinitely. Occasionally, there are associated systemic abnormalities. 2 Somatic mosaicism that develops during embryogenesis appears to be the underlying aetiology. The linear nature of the pigmented bands probably reflects the clonal migration and proliferation of embryonic melanocyte precursors (melanoblasts). 3 Recently, linear and whorled nevoid hypermelanosis have been used to encompass a wide spectrum of clinical entities, ranging from the congenital or perinatal form of Kalter and colleagues to the segmentary and delayed form of Rower and colleagues, for which there is a tendency to use the term progressive cribriform and zosteriform hyperpigmentation. 4 We report herein a case of progressive cribriform and zosteriform hyperpigmentation -the late onset linear and whorled nevoid hypermelanosis which is not associated with ...

Aquagenic acrokeratoderma

“…The latency of lesions after water contact has spanned 2–10 min, 5 as in our patients. According to the previous publications (Table 1), 1–23 AA has a predilection for adolescents and females, 21 and involvement of the palms and fingers. In addition to our patient 1, there are only three other cases in the literature with sole involvement 3,8,10 .…”

“…The transient reactive type was first reported by English and McCollough 1 in 1996, in two sisters, and was characterized by translucent to whitish papules involving the palms, associated with burning sensation after 3–5 min of water exposure; lesions resolved soon after withdrawal of water. The disorder was termed “transient reactive papulotranslucent acrokeratoderma.” Since then, more than 30 cases have been described 1–23 (Table 1) under different names, depending on the accompanying features, including “aquagenic palmoplantar keratoderma”, 3 “aquagenic syringeal acrokeratoderma”, 5 “aquagenic keratoderma”, 7 “aquagenic wrinkling of the palms”, 11 and “aquagenic acrokeratoderma” (AA) 12 . The “hand‐in‐the‐bucket” sign, when patients submerge their hands in water to demonstrate the lesions, is a diagnostic clue.…”

Painful Wrinkles in the Bathtub: Association with Hyperhidrosis and Cystic Fibrosis

“…TAPH usually develops in puberty or in the early 20s (average 20.9 years, age range 8–35), and initial reports suggested that predominantly females are affected. More recently however, several reports claiming the first description in males were almost simultaneously published [9, 15, 16]. The average duration of TAPH before consulting a physician was 14.8 months, with a range of 3 weeks to 4 years.…”

“…A search of the English literature using all proposed terms of TAPH identified 24 cases in the dermatological literature which are summarized in table 1[1,2,3, 5,8,9,10,11,12,13,14,15,16,17,18,19]. However, not included are 12 additional cases of TAPH associated with CF which were published in the 1970s by paediatricians, but lack detailed clinical information [20, 21].…”

Unilateral aquagenic keratoderma treated with botulinum toxin A

“…Falcón et al (1 case) 21 Pastor et al (3 cases) 22 Pardo et al (1 case) 23 Badazzi et al (1 case) 12 Sais et al (1 case) 24 Conde-Salazar (2 cases) 25 Luo et al (2 cases) 26 27 Polat et al (2 cases) 28 Yalcin et al (1 case) 29 Adişen et al (1 case) 30 Itin et al (1 case) 8 Suchak et al (1 case: the same case improved with aluminium hydroxide) 16 Luo et al (1 case: the same case improved with formalin 3%) 26 …”