Aquagenic Wrinkling of the Palms: Response to Topical Tacrolimus

Aquagenic wrinkling of the palms (AWoP) is a rare dermatosis of significant psychosocial embarrassment and missed employment opportunities. It is characterized by development of translucent papules and wrinkling of the palms and rarely of soles shortly after immersion in water. Associated burning pain or pruritus of variable intensity is often distressing. The symptoms subside spontaneously 10-60 minutes after drying of hands only to recur following contact with water resulting in mild palmar hyperkeratosis over time. Although, cystic fibrosis remains the most described association, its cause is unknown in majority. The treatment is usually unsatisfactory and remains challenging. Response to antihistamines, iontophoresis, topical aluminum chloride 15-20% solution, and aluminum chloride hexahydrate 20% in anhydrous ethyl alcohol remains inconsistent. Keratolytic creams, petroleum jelly and/or use of gloves are not found useful at all. This paper describes a case of AWoP treated successfully with topical tacrolimus 0.1% ointment. We feel that topical tarolimus provides an effective and safe therapeutic option in AWoP.