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Aquagenic Wrinkling of the Palms as a Screening Indicator for Cystic Fibrosis Beyond Infancy

Alexios Alexopoulos1, Dimitrios Ntokos2, Despina Briana3

  • 1First Department of Pediatrics, School of Medicine, Agia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, GRC.

Cureus
|March 3, 2026
PubMed

Insights

Aquagenic wrinkling of the palms (AWP) can help screen for cystic fibrosis (CF) in children. A brief water immersion (BIW) test showed high accuracy in identifying CF patients, supporting its use in resource-limited settings.

Area of Science:

  • Medical Diagnostics
  • Genetics
  • Dermatology

Background:

  • Aquagenic wrinkling of the palms (AWP) is linked to cystic fibrosis (CF).
  • AWP may offer a screening tool for CF beyond infancy, especially in resource-limited areas.
  • Evaluating AWP's diagnostic utility and reproducibility is crucial.

Purpose of the Study:

  • To assess the diagnostic accuracy and reproducibility of a standardized brief immersion in water (BIW) test for identifying cystic fibrosis (CF).
  • To explore AWP as a potential screening method for CF in diverse settings.

Main Methods:

  • A standardized brief immersion in water (BIW) test was conducted on 100 children with confirmed CF, 50 CFTR mutation carriers, and 100 controls.
  • Hands were immersed in water for 11 minutes, with assessments at 3, 7, and 11 minutes.
  • Transepidermal water loss (TEWL) was measured post-immersion.

Main Results:

  • Early AWP (3 minutes) was observed in 68% of CF patients versus 8% of carriers and 0% of controls.
  • Wrinkling with papule formation at 7 minutes offered optimal discrimination (94% sensitivity, 98.3% specificity).
  • A TEWL threshold of ≥ 203 g/m²/h distinguished CF patients with 86% sensitivity and 98% specificity.

Conclusions:

  • The BIW test is a rapid, reproducible, and feasible diagnostic method for CF, suitable for resource-limited settings.
  • A positive 7-minute BIW test result warrants confirmatory CF testing, such as sweat chloride analysis or CFTR genotyping.

Keywords:
aquagenic wrinkling of the palmsbiw testcystic fibrosisdiagnostic screeningpediatric dermatologytransepidermal water loss

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