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Truong A, Miller A, Asch S. Pediatric Sports Dermatology. Pediatr Rev 2024; 45:271-284. [PMID: 38689113 DOI: 10.1542/pir.2023-006040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Andrew Truong
- Department of Dermatology, University of Minnesota, Minneapolis, MN
| | - Allison Miller
- Department of Dermatology, University of Wisconsin, Madison, WI
| | - Sarah Asch
- Department of Dermatology, University of Minnesota, Minneapolis, MN
- Hometown Pediatric Dermatology PLLC, North Oaks, MN
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2
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Yang K, Zhou C, Luke J. Aquagenic wrinkling of the palms: review of the literature. Clin Exp Dermatol 2022; 47:1910-1915. [PMID: 35796149 PMCID: PMC9826168 DOI: 10.1111/ced.15323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Karen Yang
- School of MedicineUniversity of CaliforniaRiversideCAUSA
| | - Cici Zhou
- Department of DermatologyLoma Linda UniversityLoma LindaCAUSA
| | - Janiene Luke
- Department of DermatologyLoma Linda UniversityLoma LindaCAUSA
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3
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Vazquez T, Zarei M, Herskovitz I, Price A, Villada G, Keri J. Atypical familial aquagenic syringeal acrokeratoderma. J Cutan Pathol 2021; 47:991-996. [PMID: 33464626 DOI: 10.1111/cup.13704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/22/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Vazquez
- Florida International University Wertheim College of Medicine, Miami, Florida, USA.,Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mina Zarei
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ingrid Herskovitz
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alexandra Price
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gabriel Villada
- Pathology & Laboratory Medicine Service, Miami Veterans Affairs Healthcare System, Miami, Florida
| | - Jonette Keri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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4
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Paul GR, Bai S, Jackson K, McCoy KS. Aquagenic wrinkling in children under two years of age: Could this be a potential clinical referral tool for cystic fibrosis among non-screened populations? J Cyst Fibros 2021; 20:e77-e83. [PMID: 34016560 DOI: 10.1016/j.jcf.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/20/2021] [Accepted: 04/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early diagnosis via newborn screening is crucial to improve clinical outcomes in patients with cystic fibrosis (CF). In resource-limited areas where newborn screening is unavailable and CF-related morbidity is high, clinical tools such as palmar aquagenic wrinkling (AW) have been considered. We report the utility of AW for possible early identification of CF in children <2 years old. METHODS This pilot case-control study included 55 total children, 20 with confirmed CF, 10 CF carriers, and 25 healthy controls. The time to wrinkling (TTW) after hand immersion in water was recorded, and relationships between TTW, demographic and clinical variables, and validated diagnostic tests were analyzed. RESULTS Wrinkling was observed in children <2 years of age, and median TTW was significantly lower among those with CF (3 min) compared to carriers or healthy controls (12 and 14 min, respectively). Higher immunoreactive trypsinogen and sweat chloride levels were associated with lower TTW (p < 0.001). In this predominantly Caucasian cohort, children with F508del had the lowest TTW. Six minutes of hand immersion offered a sensitivity of 85% and a specificity of 91%, suggesting a practical and effective test duration for this age. There was no evidence that nutritional status affected TTW. CONCLUSION Our data confirm the role of AW in CF, validate test utility among young children, and analyze relationships between TTW, immunoreactive trypsinogen, sweat chloride levels, and CF-causing mutations. Despite test limitations, in children with suspected CF from non-screened populations, utility of AW in enabling early referral and diagnosis needs further exploration.
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Affiliation(s)
- Grace R Paul
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Shasha Bai
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA; Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
| | - Kenneth Jackson
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH, USA; Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
| | - Karen S McCoy
- Division of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
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Torres-Laboy PM, Melendez-Montañez JM, De Jesús-Rojas W. Aquagenic Wrinkling of the Palm: A Rare Diagnostic Clue of Cystic Fibrosis and the Response to CFTR-Modulating Therapy. Cureus 2021; 13:e14425. [PMID: 34007735 PMCID: PMC8121091 DOI: 10.7759/cureus.14425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Aquagenic wrinkling of the palms (AWP), also known as aquagenic palmoplantar keratoderma, is an uncommon dermatosis characterized by transient translucent whitish papules, edema, and hyper-wrinkling of the palms and soles shortly after water immersion. Approximately up to 80% of cases reported are associated with cystic fibrosis (CF) patients and up to 25% with CF carriers. We present the case of a 16-year-old male who complains of new-onset symmetrical edematous wrinkling on his palms associated with brief water exposure. After evaluation and genetic testing, the patient was diagnosed with CF and AWP. While there are numerous theories regarding the pathogenesis of AWP, no consensus has been reached regarding its etiology or relationship with CF. However, given the high prevalence of AWP associated with the genetic disease, physicians should have a high index of suspicion of CF or cystic fibrosis transmembrane regulator (CFTR)-related disease in pediatric patients with this presentation. The presence of AWP as part of the physical examination may help recognize challenging CF cases with uncommon genetic variants. Prompt recognition of CF disease leads to timely initiation of CFTR-modulating therapy, improving the patient’s health outcomes and quality of life. In this case, we also present the patient’s response to CFTR-modulating therapy and compare with baseline status.
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Affiliation(s)
| | - Jesus M Melendez-Montañez
- Biology, University of Puerto Rico, Mayagüez Campus, Mayaguez, PRI.,Pediatrics, Ponce Health Sciences University, Ponce, PRI
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Karagün E. Aquagenic acrokeratoderma due to frequent handwashing during the COVID-19 pandemic outbreak. Dermatol Ther 2021; 34:e14796. [PMID: 33484064 PMCID: PMC7995083 DOI: 10.1111/dth.14796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/02/2021] [Accepted: 01/17/2021] [Indexed: 01/14/2023]
Abstract
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.
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Affiliation(s)
- Ebru Karagün
- Department of Dermatology, Liv Hospital, Dermatology Clinic, Ankara, Turkey
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7
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From Classical to Unusual: Report on 5 Cases of Transient Reactive Aquagenic Pseudokeratoderma and Review of the Literature. Am J Dermatopathol 2017; 39:935-942. [DOI: 10.1097/dad.0000000000000815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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Reznikov LR. Cystic Fibrosis and the Nervous System. Chest 2017; 151:1147-1155. [PMID: 27876591 PMCID: PMC5472519 DOI: 10.1016/j.chest.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/13/2016] [Accepted: 11/02/2016] [Indexed: 12/31/2022] Open
Abstract
Cystic fibrosis (CF) is a life-shortening autosomal recessive disorder caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). CFTR is an anion channel that conducts bicarbonate and chloride across cell membranes. Although defective anion transport across epithelial cells is accepted as the basic defect in CF, many of the features observed in people with CF and organs affected by CF are modulated by the nervous system. This is of interest because CFTR expression has been reported in both the peripheral and central nervous systems, and it is well known that the transport of anions, such as chloride, greatly modulates neuronal excitability. Thus it is predicted that in CF, lack of CFTR in the nervous system affects neuronal function. Consistent with this prediction, several nervous system abnormalities and nervous system disorders have been described in people with CF and in animal models of CF. The goal of this special feature article is to highlight the expression and function of CFTR in the nervous system. Special emphasis is placed on nervous system abnormalities described in people with CF and in animal models of CF. Finally, features of CF that may be modulated by or attributed to faulty nervous system function are discussed.
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Affiliation(s)
- Leah R Reznikov
- Department of Physiological Sciences, University of Florida, College of Veterinary Medicine, Gainesville, FL.
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Sakiyama T, Kubo A. Hereditary palmoplantar keratoderma "clinical and genetic differential diagnosis". J Dermatol 2017; 43:264-74. [PMID: 26945534 DOI: 10.1111/1346-8138.13219] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/15/2015] [Indexed: 11/29/2022]
Abstract
Hereditary palmoplantar keratoderma (PPK) is a heterogeneous group of disorders characterized by hyperkeratosis of the palm and the sole skin. Hereditary PPK are divided into four groups--diffuse, focal, striate and punctate PPK--according to the clinical patterns of the hyperkeratotic lesions. Each group includes simple PPK, without associated features, and PPK with associated features, such as involvement of nails, teeth and other organs. PPK have been classified by a clinically based descriptive system. In recent years, many causative genes of PPK have been identified, which has confirmed and/or rearranged the traditional classifications. It is now important to diagnose PPK by a combination of the traditional morphological classification and genetic testing. In this review, we focus on PPK without associated features and introduce their morphological features, genetic backgrounds and new findings from the last decade.
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Affiliation(s)
- Tomo Sakiyama
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Akiharu Kubo
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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10
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Fernández-Crehuet P, Ruiz-Villaverde R. Dermoscopic features of aquagenic syringeal acrokeratoderma. Int J Dermatol 2016; 55:e407-8. [DOI: 10.1111/ijd.13247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/20/2015] [Accepted: 11/08/2015] [Indexed: 11/30/2022]
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Gualdi G, Pavoni L, Monari P, Calzavara‐Pinton PG, Manganoni M. Dermoscopy of drug‐induced aquagenic wrinkling phenomenon. J Eur Acad Dermatol Venereol 2015; 30:1211-2. [DOI: 10.1111/jdv.13130] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- G. Gualdi
- Department of Dermatology Spedali Civili Brescia Modena Italy
| | - L. Pavoni
- Department of Dermatology Spedali Civili Brescia Modena Italy
| | - P. Monari
- Department of Dermatology Spedali Civili Brescia Modena Italy
| | | | - M.A. Manganoni
- Department of Dermatology Spedali Civili Brescia Modena Italy
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Nadal M, Laudier B, Malinge M, Binois R, Estève E. Kératodermie aquagénique palmaire chez une patiente hétérozygote pour la mutation c.3197G>C du gène CFTR. Ann Dermatol Venereol 2015; 142:201-5. [DOI: 10.1016/j.annder.2015.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 11/04/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
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Tchernev G, Semkova K, Cardoso JC, Ananiev JJ, Wollina U. Aquagenic keratoderma. Two new case reports and a new hypothesis. Indian Dermatol Online J 2014; 5:30-3. [PMID: 24616851 PMCID: PMC3937482 DOI: 10.4103/2229-5178.126025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Georgi Tchernev
- Department of Dermatology and Venerology, Saint Kliment Ohridski University, University Hospital Lozenetz, Bulgaria
| | - Kristina Semkova
- Department of Dermatology and Venerology, Medical University Sofia, Sofia, Bulgaria
| | - José Carlos Cardoso
- Department of Dermatology, University Hospital of Coimbra, Coimbra, Portugal
| | - J Julian Ananiev
- Department of General and Clinical Pathology, Medical Faculty, Trakia University, Stara Zagora, Bulgaria
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital, Dresden-Friedrichstadt, Dresden, Germany
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14
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Wilder-Smith E. Aquagenic wrinkling of the palms is due to vasoconstriction of palmar skin vasculature. Med Hypotheses 2013; 81:963-5. [DOI: 10.1016/j.mehy.2013.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 09/03/2013] [Accepted: 09/08/2013] [Indexed: 11/28/2022]
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15
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What's new in pediatric dermatology? J Am Acad Dermatol 2013; 68:885.e1-12; quiz 897-8. [DOI: 10.1016/j.jaad.2013.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/13/2013] [Accepted: 03/15/2013] [Indexed: 11/22/2022]
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