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May 16, 2011

A 16-Year-Old With White Plaques on the Palms—Diagnosis

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Arch Dermatol. 2011;147(5):609-614. doi:10.1001/archdermatol.2011.89-b

Histopathologic examination of the specimen with hematoxylin-eosin stain revealed crenulated-appearing secretory cells lining the eccrine coils. In the epidermis, there was dilation of the acrosyringium, and a pale spongy appearance to the outer stratum corneum.

Aquagenic wrinkling of the palms, also known as aquagenic syringeal acrokeratoderma, acquired aquagenic palmoplantar keratoderma, and transient reactive papulotranslucent acrokeratoderma,1 is an uncommon dermatologic disorder characterized by symptoms of discomfort, burning, or pruritus on the palmar aspects of the hands after sustained contact with water. After exposure to moisture, physical examination reveals papules and plaques of white epidermis, hyperlinear palms, and prominent eccrine pores. The histopathologic changes of dilated acrosyringium, crenulated-appearing eccrine secretory cells, and a spongy appearance to the stratum corneum are typical,2 although the diagnosis is generally made clinically. The prevalence of AWP among the general population is unknown, but the condition is thought to be rare.

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