An unusual palmar eruption

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3852 (Published 21 September 2017) Cite this as: BMJ 2017;358:j3852
  1. Rachel Fisher, specialist registrar in dermatology,
  2. Penelope Pratsou, consultant dermatologist
  1. Department of dermatology, Royal Berkshire Hospital, Reading, UK
  1. Correspondence to R Fisher rachelfisher1{at}nhs.net

A 21 year old woman presented with episodic palmar itching, stinging, and skin peeling after brief exposure to water. Palmar water immersion in the dermatology clinic resulted in multiple whitish papules and exaggerated wrinkling after seven minutes, consistent with aquagenic palmar wrinkling (fig 1).

Aquagenic palmar wrinkling is a clinical diagnosis demonstrated by reproducible signs on water immersion. Its pathogenesis has been attributed to sweat electrolyte dysfunction. It is common in cystic fibrosis (especially homozygous DF508) but also occurs in cystic fibrosis carriers1; referral to specialist genetics services for testing is therefore essential. Aquagenic palmar wrinkling can be induced by medication or, as in our patient, can be idiopathic. Treatments include topical antiperspirants and iontophoresis.2


  • Patient consent obtained.


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