Aquagenic keratoderma. Two new case reports and a new hypothesis

Abstract

Aquagenic keratoderma has been described as a transient condition affecting predominantly young females and defined clinically by the appearance of palmar hyper-wrinkling accentuated after immersion in water. We present two new cases with aquagenic palmoplantar acrokeratoderma – a child and a young male. A significant clinical improvement was achieved after topical treatment with aluminum salts. Aquagenic palmar keratoderma may be a clue to cystic fibrosis in adolescents and young adults. We developed a new hypothesis on its pathogenesis.

Pool Toes: Case Report and Review of Pool-Associated Pedal Dermatoses

“…Asteatotic dermatitis Xerosis [1] Contact dermatitis: allergic Pool water dermatitis, swim fin dermatitis [2][3] Contact dermatitis: irritant Pool dermatitis [4] Friction-induced injury Pool toes, subcorneal hematoma [5,6] Infection: bacterial Erythrasma, gram-negative toe web infection, pitted keratolysis, pseudomonas hot-foot syndrome, toe web infection [7][8][9][10] Infection: fungal Dermatophyte infection, erosio interdigitalis blastomycetica, toe web infection [10][11][12][13] Infection: mycobacterial Mycobacterium abscessus hand-and-foot disease [14] Infection: viral Plantar verruca [11,15] Keratoderma Aquagenic keratoderma [16] Pruritus Aquagenic [17] Thermal injury Pool feet [18] Ultraviolet radiation exposure Actinic keratosis, basal cell carcinoma, drug-induced photosensitivity, melanoma, squamous cell carcinoma, sunburn [15] Urticaria Aquagenic, cold-induced, contact [17,19,20] Swimmer's xerosis is a form of asteatotic dermatitis that presents with dryness, itching, and scaling of the skin, including the feet. Symptoms are more pronounced in the cooler winter months, and the dryness is exacerbated when the swimming is followed by a prolonged, hot shower.…”

“…The friction-induced injury resulted in early blister formation not only on the plantar surface of her toes but also on the areas of her soles--including her heels--that came in contact with the rough swimming pool surface. In addition to discussing the characteristics of pool toes, the features of other pool-associated pedal dermatoses are reviewed [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

A new trigger for aquagenic wrinkling: Isotretinoin

“…Some authors have pointed it out as the disorder of the autonomic nervous system and have focused on the association of this disease with the increase in sympathetic activity. [5] In this respect, the sympathetic activity, which is already increased in acne patients, combined with the possible synchronizing effect of isotretinoin could cause such an exaggerated response resulting in wrinkling of palmar skin.…”

Atypical aquagenic keratoderma treated with oxybutynin chloride

“… 1 Unlike the bilateral involvement of palms and soles reported in most cases, our patient had an atypical involvement of dorsum of hands, wrists and ankles akin to previous reports. 2 , 3 …”

“…The etiopathogenesis is still a topic of debate and various theories proposed include, alteration in the salt concentration of the epidermal cells, increase in the water-binding capacity of keratins, alteration of the barrier function of stratum corneum, role of the osmosensitive receptor transient vanilloid receptor type -1 (TVRT-1), and an increased expression of aquaporins. 3 …”