Excessive Wrinkling on the Dorsum of the Hands and Wrists

Abstract

An otherwise healthy man in his 20s presented to the dermatology department with thickening and swelling of hands after immersion in water, accompanied by burning pruritus for 3 years. The lesions occurred as symmetrical white and transparent papules, white keratosis, excessive wrinkling on the dorsum of hands after water immersion and worsened in summer, and remitted in winter. He was treated with topical tretinoin ointment intermittently per a diagnosis of chronic eczema at the local clinic with little improvement. The lesions gradually aggravated, and the affected area dispersed to wrists and elbows during past the 1.5 years. He attributed these changes to the need for washing hands frequently in the period of the COVID-19 epidemic. He had no family history of similar skin problems and did not have a history of hyperhidrosis, cystic fibrosis, atopy, or trauma to the hands.Physical examination showed some changes emerged on both hands after water immersion contrasting with any other condition (Figure , A and B). We took a skin biopsy specimen from white papules on the right hand, and representative histopathologic features are shown in the Figure, C and D.