Aquagenic Syringeal Acrokeratoderma

Aquagenic syringeal acrokeratoderma is a newly described disease entity of unclear etiology, affecting predominantly adolescents and young adults. It manifested as multiple whitish papules on the palms or rarely soles, which became accentuated after immersion in water and improved after drying the involved area. Burning, pain, pruritus or tightening sensation may be present and usually there is an association with palmar hyperhidrosis. The histopathology revealed dilated sweat duct ostia with focal mild hyperkeratosis. Most patients responded well to topical aluminum chloride, but recurrence could occur. We presented a 19-year-old healthy male with multiple whitish, translucent, asymptomatic papules mainly on his left palm for 7 years. Such a condition became more pronounced after exposure to warm water and resolved to residual smaller flesh-colored to white papules after a drying period. He reported occasional mild palmar hyperhidrosis of his left hand and had a family history of atopy. The dermatoscopy revealed dilated puncta on the papules. The histopathologic examination revealed dilatation of intracorneal eccrine ducts with mild focal hyperkeratosis and acanthosis. After receiving topical 20% anhydrous aluminum chloride nightly for 5 weeks, he reported almost disappearance of the papules when the palms were dry.