Learning Objective
- To recall key diseases associated with aquagenic wrinkling of the palms
A 16-year-old presents to the office with her parent. They are concerned because over the last two months, when the patient swims or does a heavy workout, the palms of her hands start severely wrinkling within the first three minutes.
The patient demonstrates by dipping her hands in water in the sink during the office visit. The rapid change to the skin is promptly recognized as aquagenic wrinkling of the palms. Aquagenic wrinkling of the palms is described as severe wrinkling when exposed to water or large amounts of sweat. The condition can also be accompanied by a burning sensation and pruritis.
The condition is most strongly associated with cystic fibrosis including those that are carriers of the gene, but can also be found with focal hyperhidrosis, marasmus, atopic dermatitis, Raynaud phenomenon and patients using COX-2 inhibitors.
The patient is tested for cystic fibrosis and is positive for a carrier gene.
Aquagenic wrinkling of the palms develops characteristically in a younger age than this patient. In this case the phenomenon developed later, most likely because of the patient’s carrier state.
The pathogenesis is believed to be linked to the hypersaline cutaneous environment that is present with cystic fibrosis and to a lesser extent with those that carry a single cystic fibrosis gene as well as other conditions that increase the sodium content of the sweat such as child malnutrition, specifically marasmus and COX-2 inhibitors that increase the sodium in sweat as well as the kidney. Although the etiology and pathogenesis have not been precisely defined, it is important to remember to screen for cystic fibrosis when aquagenic wrinkling of the palms is observed.
Aquagenic wrinkling of the palms is treated by drying the hands and the feature will disappear in roughly 60-90 minutes. If the condition is bothersome to the patient, 20% topical aluminum chloride can be applied to the palms of the hands to help decrease moisture and prevent development of wrinkling.
Further Reading
References
Berk DR, Ciliberto HM, Sweet SC, Ferkol TW, Bayliss SJ. Aquagenic Wrinkling of the Palms in Cystic Fibrosis: Comparison With Controls and Genotype-Phenotype Correlations. Arch Dermatol. 2009;145(11):1296–1299. doi:10.1001/archdermatol.2009.260
Katz KA, Yan AC, Turner ML. Aquagenic Wrinkling of the Palms in Patients With Cystic Fibrosis Homozygous for the ΔF508 CFTR Mutation. Arch Dermatol. 2005;141(5):621–624. doi:10.1001/archderm.141.5.621
Katz M, Ramot Y. Aquagenic wrinkling of the palms. CMAJ. 2015 Dec 8;187(18):E515. doi: 10.1503/cmaj.150074. Epub 2015 Aug 17. PMID: 26283724; PMCID: PMC4674424.
Uptodate [Internet]. [cited 2022 Nov 25]. Available from: https://www.uptodate.com/contents/iga-vasculitis-henoch-schonlein-purpura-clinical-manifestations-and-diagnosis
Originally published June 8, 2021; updated February 10, 2023
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