Aquagenic Syringeal Acrokeratoderma (Transient Reactive Papulotranslucent Acrokeratoderma)

Abstract

In 1996, English and McCollough described an unusual entity in 2 sisters characterized by a transient and recurrent keratoderma exclusively on the palms after water exposure. The condition developed 3–5 min after exposure to water and resolved within a short time after drying. This finding was associated with a tightening sensation. Yan et al. coined the term ‘aquagenic palmoplantar keratoderma’, and the designation ‘aquagenic syringeal acrokeratoderma’ was suggested by MacCormack et al. Until now, a total of 8 cases have been reported. We documented 2 new cases with acquired aquagenic syringeal acrokeratoderma. A 25-year-old female had observed within the last 3 months a burning sensation on the palms after some minutes of water contact. Physical examination revealed a perfectly normal skin on the palms. Three minutes after water immersion of 20°C, a whitish discoloration appeared on the palms and a thickening of the palmar skin was visible. In addition, the eccrine pores were much more prominent. Few minutes after drying the skin, the situation returned to a normal state. The second patient, a 33-year-old female noticed a painful whitish discoloration of the skin on the palms after a short period of water immersion. Sometimes the white skin could be peeled off. In the last year, hyperhidrosis developed, and a more reddish aspect of the palms appeared. In our office after rinsing the hands with water at room temperature, a whitish discoloration in the center of the palms appeared which was associated with a painful sensation. After drying, the whitish lesions disappeared almost completely within 30 min. Aquagenic palmar keratoderma describes an acquired and transient condition which occurs after brief exposure to water and disappears after drying within minutes to an hour. Only rarely may a slight hyperkeratosis remain for a longer time. The possible pathophysiology and treatment options are discussed.

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

“…To describe this phenomenon which may be easily distinguished from physiologic water-induced skin wrinkling, several terms have been used in the literature, e.g. aquagenic papulotranslucent or syringeal acrokeratoderma, hand-in-the-bucket sign, and others [1,2,3,4,5]. While the exact pathophysiologic mechanism of TAPH is currently unknown, increased water absorption due to an abnormal quantity and/or composition of sweat and the decreased barrier function of the epidermis seem to be important factors [4].…”

Unilateral aquagenic keratoderma treated with botulinum toxin A

“…Another theory proposed that AK is a disorder of the integrity of the stratum corneum, resulting in increased water absorption. 8 Our patient had a hyperkeratosis of the right palm developing progressively over the years which suggests that his hyperkeratosis is rather a secondary phenomenon induced by repeated exposure to water. Moreover he did not have associated hyperhidrosis.…”

“…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 …”

“…Lim et al (1 case) 34 MacCormack et al (2 cases) 7 Itin et al (1 case) 8 No treatment Spontaneous resolution…”

“…2,9 Spontaneous resolution has been reported in 4 cases and some cases clear after a few years. 8,11,12 Table 1 shows a list of all the cases of AK reported in the medical literature and their response to treatment. Modalities of treatment usually used for hyperhidrosis, such as aluminium chloride hexahydrate and iontophoresis, have been efficacious in treating several patients with AK.…”