Aquagenic palmoplantar keratoderma: A report of five cases

Abstract

Aquagenic palmoplantar keratoderma (APK), predominantly occurring in adolescents and females, is a rare condition that occurs after brief exposure to water and disappears minutes to an hour after drying. We experienced five cases of APK during 8 years from 2005 to 2013. All five cases were young females ranging in age from 3 to 17 years. The patients had a history of erythema with/without itchy hyperkeratosis, and whitish discoloration on the hands and/or feet after sweating on exercise or immersion in water for a few minutes. We performed the test of placing their hands or feet in water in order to demonstrate the symptom. The patients were diagnosed with APK because they displayed the"hand in the bucket"sign. Without immersion in water, three cases (Cases 1, 3 and 5) showed slight scaling and hyperkeratosis revealed hand eczema, while the other two cases (Cases 2 and 4) revealed hyperkeratosis identical to palmoplantar keratoderma. Biopsy specimens from Cases 1 and 2 showed hyperkeratosis, dilated eccrine ducts in the epidermis. All cases were treated with topical aluminum sulfate solution, which in four of the cases resulted in evident improvement. If a young female patient presents with intractable eczema or hyperkeratosis on the hands and feet, it should be assessed whether she displays whitish discoloration after exercising or immersion in water. A patient who is slightly suspected of having APK should be requested to place the hands in water to demonstrate the lesions.