Hereditary papulotranslucent acrokeratoderma. A new variant of familial punctate keratoderma?

Sporadic and familial cases of aquagenic keratoderma

BACKGROUND

Aquagenic keratoderma is a dermatosis characterized by transient whitish and transluscent hyperwrinkling after water exposure. The aim of the current report was to present a sporadic and familial cases of aquagenic keratoderma.

OBSERVATION

Sporadic Case: A 38-year-old female patient presented with eruption in the right hand after exposure to water. The patient was placed on systemic acitretin therapy with the diagnosis of idiopathic acquired aquagenic keratoderma. No recurrence occurred during a 6-month follow-up period. Familial Cases: A 55-year-old male patient, who was engaged in fishery, presented to the outpatient clinics of the department of dermatology due to whitish vesicles in the palms of both hands. It was realized that the father, sister, and brother of the patient had similar complaints. The cases were thought to have familial aquagenic keratoderma; however acitretin therapy could not be initiated due to elevated alanine aminotransferase and triglyceride levels. Topical application of salicylic acid 10% and 10% urea containing lotions was effective but did not prevent recurrence.

CONCLUSION

Systemic acitretin may be an effective agent in the treatment of aquagenic keratoderma, and topical application of 10% salicylic acid and 10% urea-containing lotion did not prevent recurrence.

Aquagenic syringeal acrokeratoderma

Aquagenic syringeal acrokeratoderma is a rare, transient, and usually bilaterally symmetric, palmoplantar keratoderma. Patients complain of tingling and pain in the hands starting a few minutes after exposure to water and lasting for 20-30 minutes after removal. Clinically, there is marked wrinkling with edematous white papules on the palms or, less often, the soles. We present the case of a 21-year-old woman who used spironolactone for polycystic ovary syndrome and had similar clinical features 2 weeks later, after withdrawing the drug.

Whitish papules on the palm

A 21-year-old woman presented with a 1-month history of whitish bubbling of the palms after brief exposure to water. The symptoms arose within 3-5 min after immersion in water, as a white sponge-like appearance, and resolved after a variable drying period. She was otherwise healthy and did not complain of hyperhidrosis. There was no family history of similar lesions. Physical examination revealed a healthy appearance of the palms; however, 5 min after immersion of the hands in warm water, the central part of the left palm became swollen and tiny white papules with dilated puncta appeared. The right palm also showed similar changes. These asymptomatic papules with a tendency to coalesce became more prominent with prolonged exposure (Figs 1 and 2). The lesions resolved completely approximately 30 min after removal of the hands from water. A biopsy taken from the lesional skin revealed dilatation of intraepidermal eccrine ducts and a spongy appearance in the corneal layer (Fig. 3). A diagnosis of aquagenic syringeal palmar keratoderma was made on the basis of these clinical and histopathologic findings. A short course of treatment with topical aluminum chloride resulted in a remarkable response in 1 week. She had no recurrence after 1 year.

Transient aquagenic palmar hyperwrinkling: the first instance reported in a young boy

Transient reactive papulotranslucent acrokeratoderma is a rare palmoplantar keratoderma seen predominantly in adolescent and young adult women. Clinically it is characterized by translucent white papules generally involving the palmar surfaces after exposure to water. The typical "hands-in-the-bucket" sign, which is not clearly visible until the hand is submerged in water, is indispensable for the diagnosis. Histologic examination shows a mild orthokeratotic hyperkeratosis and dilated eccrine ducts. We propose the term "transient aquagenic palmar hyperwrinkling" to describe this condition. Until now, a total of 12 patients have been reported in the literature, all female, with an age of onset from 9 to 33 years. We present the first reported instance of this condition in a young boy.

Transient reactive papulotranslucent acrokeratoderma associated with cystic fibrosis

A 20-year-old female with cystic fibrosis presented with a white marginal palmar eruption after exposure to water. There was no family history of keratoderma. A biopsy showed hyperkeratosis around dilated eccrine ostia. These features are similar to a recently described condition, transient reactive papulotranslucent acrokeratoderma. This is thought to be a variant of hereditary papulotranslucent acrokeratoderma, one of the punctate keratodermas. Association with cystic fibrosis has not been described previously.

A new variant of punctate acrokeratoderma associated with a pigmentary disorder

We report a Japanese patient with skin-coloured keratotic papules on the hands and feet, and pronounced hyperkeratosis of the palms and soles. There was no evidence of fragmentation of dermal elastic tissue on histology. Freckle-like pigmentation was also present on the dorsa of the hands and feet, and this appeared to be closely related to the keratotic disorder. The mode of inheritance was autosomal dominant. We consider our case to be a new variant of familial punctate acrokeratoderma, associated with a pigmentary disorder.

Mosaic acral keratosis

We describe two patients with acral keratosis with a striking mosaic or jigsaw-puzzle pattern of keratotic papules on the dorsal aspects of the feet and adjacent parts of the legs. Both patients also showed mild diffuse palmoplantar keratosis and clavus-like lesions over the interphalangeal joints of the toes; one patient also had keratotic papules on the hands and hyperkeratotic plaques over the knees. The differential diagnosis of acral keratoses, including several recently described forms, is briefly discussed.

A prospective study of the effects of weekly oral methotrexate on liver biopsy

The results are reported of a prospective study of liver histological findings in twenty-five patients with severe psoriasis subjected to liver biopsy before and at intervals after the onset of treatment with methotrexate by an intermittent dosage schedule. The pre-methotrexate liver biopsy findings in forty-one other severe psoriatics are also summarized. Of the twenty-five treated patients, four showed a mild inflammatory cell infiltrate and two mild fibrosis before treatment. During treatment only one developed a grade 2 infiltrate and one other grade 2 fibrosis. None has developed cirrhosis. Where minor abnormalities developed, their fluctuating and reversible nature is demonstrated.