Friday, January 06, 2017

Aquagenic Wrinkling of the Palms

The patient is a 19 yo woman who presents with a four month history of a peculiar eruption of her palms after showering.  She spends 15 - 20 minutes in the shower.  The process resolves within a 1/2 hour.  It is mildly pruritic.

O/E:  The eruption is comprised of 1 - 2 mm in diameter white papules, discrete and confluent, on the palms.  We demonstrated these lesions in the office and they cleared within 10 minutes.  Here feet are unaffected, by history.

Clinical Photos provided by patient: (directly after shower, and when returned to baseline.

 Diagnosis:  Aquagenic Wrinkling of the Palms

Question:  The literature states that this is more common in people with cystic fibrosis and CF carriers.  This patient has no history to suggest CF.  Should genetic testing be offerred? 

Reference: There are many case reports; but the Dermnet site is a great overview. 

CF Genetic Testing. (from Cystic Fibrosis Foundation web site)
In the United States, the number of people who carry a CF gene mutation is about:
  • 1 in 29 Caucasian-Americans
  • 1 in 46 Hispanic-Americans
  • 1 in 65 African-Americans
  • 1 in 90 Asian-Americans

1 comment:

  1. Comments from pediatric dermatologists:
    1. My mentor Alfie Krol taught me that at minimum we should counsel patients with aquagenic wrinkling about the possibility that they may be a CF carrier. I do each time, and offer to refer to genetics. I've had a couple of parents choose to have their children tested, and both have been negative for CF mutations.
    2. I also think counseling the patient and family is important. If there is a pertinent medical history of the condition in the family, the genetic testing seems to be reasonable, otherwise careful observation with symptomatic treatment seems to be appropriate.


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