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Aquagenic wrinkling of the palms (AWoP) is a rare dermatosis of significant psychosocial embarrassment and missed employment opportunities. It is characterized by development of translucent papules and wrinkling of the palms and rarely of soles shortly after immersion in water. Associated burning pain or pruritus of variable intensity is often distressing. The symptoms subside spontaneously 10-60 minutes after drying of hands only to recur following contact with water resulting in mild palmar hyperkeratosis over time. Although, cystic fibrosis remains the most described association, its cause is unknown in majority. The treatment is usually unsatisfactory and remains challenging. Response to antihistamines, iontophoresis, topical aluminum chloride 15-20% solution, and aluminum chloride hexahydrate 20% in anhydrous ethyl alcohol remains inconsistent. Keratolytic creams, petroleum jelly and/or use of gloves are not found useful at all. This paper describes a case of AWoP treated successfully with topical tacrolimus 0.1% ointment. We feel that topical tarolimus provides an effective and safe therapeutic option in AWoP.

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Gürel G, Şahin S, Çölgeçen E. A case of aquagenic syringeal acrokeratoderma with involvement of periungual area of the hand. Turk J Pediatr 2018; 60: 762-764. Aquagenic syringeal acrokeratoderma (ASA) is a rare form of palmoplantar keratoderma occurring after short-term contact with water. Although ASA usually involves the palmar region, there are also several cases with the involvement of dorsum of hand and sole of the feet. We described 15-year old girl who had white keratodermic plaques observed on the flexor side of distal phalanxes especially the periungual area after a 10 min contact with water. Our patient represents a rare case of ASA with the involvement of periungual region of the fingers.

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Aquagenic syringeal acrokeratoderma is a rare, transient, and usually bilaterally symmetric, palmoplantar keratoderma. Patients complain of tingling and pain in the hands starting a few minutes after exposure to water and lasting for 20-30 minutes after removal. Clinically, there is marked wrinkling with edematous white papules on the palms or, less often, the soles. We present the case of a 21-year-old woman who used spironolactone for polycystic ovary syndrome and had similar clinical features 2 weeks later, after withdrawing the drug.

Aquagenic syringeal acrokeratoderma is a newly described condition of the palms and soles characterized by hypopigmented papules and plaques, elicited after submersion in water. Symptoms include a burning pain and a tightening sensation in the palms, as well as hyperhidrosis. Initially thought to be rare, its frequent citation in the literature points to a more common entity. It is more often found in young women and has been linked to a number of medications and illnesses, including nonsteroidal anti-inflammatory drugs and cystic fibrosis. It is typically self-limiting, but certain medications such as topical aluminum chloride or salicylic acid ointment have been found to be an effective treatment option. This case details a collegiate-level coxswain who presented to the university athletic training room with a typical presentation of aquagenic syringeal acrokeratoderma. For an aquatic athlete, aquagenic syringeal acrokeratoderma can be a distressing condition that can limit training and athletic participation. As such, the sports medicine physician should be knowledgeable about aquagenic syringeal acrokeratoderma to provide effective counseling and treatment options for the athlete.

Aquagenic syringeal acrokeratoderma is a rare acquired disorder that predominantly affects young women. It is most commonly localised on the palms. It is characterised by translucent papules, oedematous plaques and keratoderma developing after brief exposure to water and resolving shortly after drying. We have observed 10 patients with this disorder within 13 months. We think that aquagenic syringeal acrokeratoderma is a more common condition than was originally anticipated as one can easily underdiagnose this entity due to the transient nature of its clinical findings.