Aquagenic acrokeratoderma

Aquagenic wrinkling of the palms: review of the literature

Aquagenic wrinkling of the palms (AWP) is a rare dermatological disease characterized by development of rapid and excessive wrinkling and oedema of the palms and transient whitish or yellowish papules without erythema on the palmar surfaces after immersion in water. This phenomenon can be accompanied by pain and/or pruritus. The most common treatment of AWP involves aluminium-based topicals. This article discusses the associations, pathological mechanisms and treatment options of AWP.

Ungewöhnliche Waschfrauenhände – aquagenes Akrokeratoderm bei CFTR-Mutation

Das aquagene Akrokeratoderm manifestiert sich klinisch in Form von weißlichen, transluzenten Papeln und Plaques an den Hand- und seltener Fußflächen, welche wenige Minuten nach Wasserkontakt auftreten und mit Brennen, Juckreiz oder Schmerzen einhergehen können.

Das Krankheitsbild kann idiopathisch oder auch im Rahmen einer zystischen Fibrose auftreten. Eine Assoziation mit Hyperhidrose wird ebenfalls beschrieben.

Wir berichten über eine junge Patientin mit neu aufgetretenem aquagenem Akrokeratoderm der Handflächen, bei der wir im Verlauf eine CFTR-Mutation nachweisen konnten.

Aquagenic acrokeratoderma due to frequent handwashing during the COVID-19 pandemic outbreak

Aquagenic acrokeratoderma (AK) is a rare, transient type of acquired palmoplantar keratoderma resulting from short‐term contact with water and characterized by white, transparent papules and plaques usually localized in the palmar regions of the hand. The pathogenesis of aquagenic acrokeratoderma is not fully understood and is assumed to be related to an increased salt concentration in the epidermal cells with an increase in the ability of stratum corneum to bind water. This report of patients developing AK following increased frequencies of handwashing in the COVID‐19 Pandemic Outbreak is intended to contribute to our understanding of the pathogenesis.

Aquagenic (pseudo) keratoderma (aquagenic palmoplantar keratoderma, aquagenic wrinkling of palms)

Aquagenic palmoplantar keratoderma (APK) is an uncommon hereditary or sporadic condition that is characterized by edematous flat-topped papules appearing on palmar skin with wrinkling after brief water exposure. APK has been associated with cystic fibrosis (CF), presenting with the same mutations found in CF (usually ΔF508 of the CFTR gene), either homozygous or heterozygous. APK may be idiopathic or drug-induced. The diagnosis is easily made if one is aware of this entity. Topical aluminum hydroxide and botulinum toxin injections are the most commonly used treatments. The sporadic form may have a shorter course compared with the hereditary one, resolving spontaneously after a few years. The condition should no longer be considered a true keratoderma but rather a pseudo keratoderma, and in spite of the many different names found in the literature, the term "aquagenic (pseudo) keratoderma" seems to be the most appropriate one.

Inhibitory effect of potassium alum on smooth muscle contraction of rabbit and its mechanism

OBJECTIVE

To investigate the effects of potassium alum (Alunite) on smooth muscle contraction and phosphorylation of myosin light chain by myosin light chain kinase (MLCK) and to try to find out the clue of its mechanism.

METHODS

An isolated rabbit duodenum smooth muscle strip was selected to study the effects of potassium alum on its contractile activity under the condition of Krebs' solution using HW-400S constant temperature smooth muscle trough. The myosin and MLCK were purified from chicken gizzard smooth muscle. Myosin light chain phosphorylation was determined by glycerol-polyacrylamide gel electrophoresis; myosin Mg2+-ATPase activity was measured by inorganic phosphate liberation method.

RESULTS

Potassium alum (2.5-20 mmol/L) inhibited the contraction on duodenum in a dose-related and a time-dependent manner; potassium alum could also inhibit the extent of phosphorylation of myosin light chain in a dose-related and a time-dependent manner; and potassium alum inhibited the extent of Mg2+-ATPase activity in a dose-related manner.

CONCLUSIONS

Potassium alum inhibited smooth muscle contraction in a way of inhibiting phosphorylation of myosin light chain and Mg2+-ATPase activity. This has revealed the molecular mechanism of treatment of gastrointestinal spastic disorders by potassium alum.

Aquagenic keratoderma. Two new case reports and a new hypothesis

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.

Unilateral aquagenic keratoderma treated with botulinum toxin A

BACKGROUND

Aquagenic keratoderma is a rare transient disease that occurs after water immersion and disappears shortly after drying. Most cases involve the palms and fingers bilaterally but it can also affect the soles. Few cases have been associated with drugs but its pathogenesis remains unclear.

MAIN OBSERVATION

We report a 60-year-old man with a 30-year-history of aquagenic keratoderma of the right palm without associated hyperhidrosis or history of drug intake. After unsuccessful treatment with 15% aluminium chloride hexahydrate gel, botulinum toxin A injections led to significant improvement within 2 weeks.

CONCLUSIONS

To our knowledge, this case is the first report of idiopathic unilateral aquagenic keratoderma in the medical literature. It is the third report of successful treatment with botulinum toxin A which is in favor of a role of sweat glands in the pathogenesis of aquagenic keratoderma.