Two Cases of Aquagenic Wrinkling of the Palms in Korean Healthy Women: Easily Overlooked Disease

Abstract

Aquagenic wrinkling of the palms (AWP) is a rare condition, which is characterized by appearance of whitish papules and plaques and an excessive wrinkling and swelling of the palmar skin after exposure to water. Herein, we report two cases of AWP. A 17-year-old woman presented prickling focal various sized whitish papules, plaques with wrinkles on both palms after water contact for 6 months ago. Histologic findings were consistent with AWP. A 26-year-old woman presented asymptomatic multiple various sized whitish papules, plaques with wrinkles on both palms after water contact for 1 year ago. Both patients underwent a cystic fibrosis transmembrane conduct receptor test but were negative and improved without any treatment.

Aquagenic wrinkling of the palms: review of the literature

“…AWP is characterized by the excessive wrinkling and the development of oedematous translucent, yellow or whitish plaques and papules on the palms after exposure to water. 4 Normal pathological wrinkling of palmar skin occurs after 11 min of water immersion, whereas AWP usually occurs within 3 min of water immersion 5 and may be accompanied by pain and/or pruritus. 6 An example of the exaggerated wrinkling in both palms in AWP, along with keratotic, pebbly, white plaques and prominent eccrine ostia is shown in Fig.…”

A Case of Idiopathic Aquagenic Wrinkling of the Palms Successfully Treated with 20% Aluminum Chloride Hexahydrate

“…AWP is a rare condition that presents as wrinkling, whitish papules, and occasionally pruritus or pain in the palms upon immersion in water irrelevant of temperature 1 . Although AWP is generally idiopathic, genetic predisposition such as possession of cystic fibrosis transmembrane conductance regulator ( CFTR ) gene mutation may be a causal factor.…”

“…While AWP is often diagnosed in Caucasians in association with cystic fibrosis, it is rarely found in Asia where CFTR gene mutation is uncommon 2 . So far, 4 cases of AWP have been reported in Korea, 2 males and 2 females in their 10 s and 20 s 1 2 3 . Skin biopsy was performed in all four cases, and all cases had histopathologic findings consistent with AWP.…”

“…There are also reports of botulinum injection achieving symptom improvement in refractory cases in which topical treatment was ineffective 5 . Of the 4 cases reported in Korea to date, 3 cases showed spontaneous improvement in symptoms, and 1 case showed improvement after treatment with topical 20% aluminum chloride hexahydrate 1 2 3 . Our patient did not improve naturally; hence, 20% aluminum chloride hexahydrate treatment was prescribed, and treatment outcome was favorable especially on pruritus.…”