Aquagenic Keratoderma

Aquagenic keratoderma is a rare skin condition in which the skin of the palms (and sometimes soles) becomes swollen, pale-white, and wrinkled within minutes of touching water. Small raised patches can appear, and people often feel tightness, burning, or itch. The changes fade after the skin dries. Doctors often use the terms “aquagenic wrinkling of the palms” and “aquagenic syringeal acrokeratoderma” for the same pattern. The condition is strongly linked with cystic fibrosis (CF) and with being a CF gene carrier. Because of that link, finding aquagenic wrinkling can be a clue that a person should be tested for CF, especially in children or teens. The diagnosis is usually made by history plus a short water-soak test (“hand-in-the-bucket” sign), and sometimes a small skin biopsy. DermNet®+2PMC+2

Scientists think the upper skin layers and sweat ducts in the palms take up too much water and salt, and the tiny sweat-gland openings may be structurally abnormal. In CF and CF-carrier states, the CFTR protein is altered, changing how salt and water move in the skin; this likely speeds up wrinkling when the skin gets wet. Some medicines can trigger similar wrinkling (drug-induced cases), especially certain COX-2 pain relievers (for example, rofecoxib, celecoxib) and aspirin; rare cases followed tobramycin use in people with CF. PubMed+2PMC+2

Aquagenic keratoderma is a rare skin condition in which small pale or white bumps and extra wrinkling quickly appear on the palms (and sometimes soles) after brief contact with water. The skin can feel tight, itchy, burning, or tender. The changes usually show up within 3–5 minutes of water exposure and fade after the hands dry. Doctors also call this problem aquagenic wrinkling of the palms (AWP), aquagenic palmoplantar keratoderma (APPK), aquagenic syringeal acrokeratoderma (ASA), or transient reactive papulotranslucent acrokeratoderma (TRPA). These terms describe the same clinical picture seen by different groups at different times. DermNet®+2PubMed+2

Other names

You may see any of the names below in articles, clinic letters, or textbooks. Doctors use them interchangeably:

• Aquagenic wrinkling of the palms (AWP) — the most common modern name. DermNet®

• Aquagenic (palmoplantar) keratoderma (APK/APPK) — highlights that palms/soles develop thickened, water-swollen outer skin. VisualDx

• Aquagenic syringeal acrokeratoderma (ASA) — points to sweat duct (syringeal) involvement. PMC

• Transient reactive papulotranslucent acrokeratoderma (TRPA) — an older term first described in 1996. PubMed

Aquagenic keratoderma is a harmless but annoying reaction of the skin’s outer layer and sweat ducts to water. When skin immersed in water absorbs and holds extra water, the top layer (stratum corneum) swells and the tiny openings of the sweat ducts (eccrine acrosyringia) become more visible. This produces quickly appearing, soft, white or translucent papules that merge into swollen, wrinkled plaques. People often feel tightness, stinging, or itch while the skin is wet; symptoms settle as the hands dry. The condition can occur on both palms, sometimes on soles, and rarely on other sites (like the face). It is strongly linked to cystic fibrosis and carriers of CFTR gene variants, but it can also occur without CF. DermNet®+2JAMA Network+2

Scientists think several mechanisms may add together: extra salt in sweat changing water movement in the skin (seen in cystic fibrosis), over-activity or structural change in sweat glands, and changes in water channels such as aquaporin-5 inside the gland cells. These factors make the skin take up water faster than normal and wrinkle sooner. DermNet®+1

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Types

Clinicians don’t use a single official “type” list, but in practice they sort aquagenic keratoderma in helpful ways:

1. CF-associated vs. non-CF (idiopathic) aquagenic keratoderma
   In cystic fibrosis or CF carrier states, high-salt sweat and CFTR dysfunction are common and the wrinkling appears very quickly and is often more marked. In people without CF, the condition can still occur and is called idiopathic. JAMA Network+1

2. Drug-induced aquagenic keratoderma
   Certain medicines can trigger the same water-induced changes; symptoms usually improve after the drug is stopped. (Details under “Causes.”) PMC+1

3. With hyperhidrosis (excess sweating) vs. without
   Some patients also sweat excessively, which seems to worsen the problem; others do not. Treatments that reduce sweating often help. DermNet®

4. By older names that emphasize appearance
   ASA, TRPA, and APPK are largely descriptive labels for the same reaction (fast wrinkling, translucent papules after water). PMC+1

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Causes

Each item below is written simply. Many people have more than one contributing factor.

1. Cystic fibrosis (CF) — CF patients have salty sweat and CFTR channel problems; they wrinkle faster and more intensely after water. Aquagenic wrinkling is common enough that it can be a clue to undiagnosed CF. JAMA Network

2. CF carrier state (one CFTR variant) — Family members without full CF can still show aquagenic wrinkling more quickly than the general population. DermNet®

3. Aspirin (acetylsalicylic acid) — Several case reports show palm wrinkling triggered by aspirin that resolved after stopping it. eScholarship

4. Rofecoxib and other COX-2 inhibitors — Reported to induce aquagenic wrinkling in single cases; removing the drug improved symptoms. eScholarship

5. Indomethacin (a non-selective NSAID) — In combination with sulfasalazine, indomethacin triggered aquagenic wrinkling in a young man; stopping the drugs cleared lesions. PMC

6. Sulfasalazine — The same report implicated sulfasalazine with indomethacin as a trigger. PMC

7. Ibuprofen — A recent two-case series described AWP associated with ibuprofen use. PMC

8. Isotretinoin — Case reports suggest isotretinoin can bring on aquagenic wrinkling, likely by altering barrier function and sweat control. PubMed+1

9. Atopic dermatitis / impaired skin barrier — Atopy makes skin leakier and more water-absorbent; one case linked drug-associated AWP to atopy. PMC

10. Primary palmar hyperhidrosis — Extra sweating increases salt and water at the skin surface and can aggravate the reaction. DermNet®

11. Adolescent and young adult age — Many cases start in teens/young adults, possibly due to sweat gland activity patterns. jpeds.com

12. Female sex (slight predominance in series) — Several reports noticed more cases in females, though all sexes can be affected. Karger

13. Warm water or long exposure — Warmer water and longer immersion speed up wrinkling; AWP often appears within 3 minutes. DermNet®

14. Frequent hand-washing / sanitizer era — Increased water contact during outbreaks like COVID-19 was suggested as a trigger in reports of ASA. Lippincott Journals

15. Aquaporin-5 (AQP5) changes in sweat glands — Microscopy shows abnormal AQP5 distribution in gland cells, supporting a water-channel role. PubMed

16. Eccrine duct (acrosyringium) dilation — Pathology often shows widened sweat duct openings, making water pooling and wrinkling more visible. DermNet®

17. Genetic variants affecting water handling — Beyond CFTR, research explores other genes (like AQP5) that could alter water flow in skin. Jid Online

18. Malnutrition/low body mass in some reports — A review mentioned links with malnutrition, possibly through barrier weakness. PubMed

19. Autonomic (sweat nerve) factors — Sudomotor nerve activity controls sweat; abnormal patterns can change water/salt on the skin. Cleveland Clinic+1

20. Idiopathic (no clear cause) — Many people have AWP with no identifiable trigger; it is still benign and manageable. DermNet®

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Symptoms

1. Fast wrinkling — Obvious wrinkling appears within 3–5 minutes of water contact, much faster than normal water wrinkling. DermNet®

2. Translucent or white papules — Tiny raised bumps merge into soft plaques on wet skin. DermNet®

3. Skin tightness — A pulling or tightening sensation during immersion is common. DermNet®

4. Burning or stinging — Some people report mild burning when the hands are wet. MDEdge

5. Itching — Itch can accompany the papules and fades after drying. MDEdge

6. Tenderness or pain — The fingertips may feel sore while wrinkled. skin.dermsquared.com

7. Swelling (edema) of the top skin layer — The stratum corneum looks puffy and accentuates creases. DermNet®

8. Distorted dermatoglyphics — Fingerprint lines look blurred or exaggerated when wet. PMC

9. Symmetric palm involvement — Most patients have both palms affected; soles may be involved. DermNet®

10. Occasional unilateral or patchy cases — Rarely, only one side or one area is affected. PMC

11. Sole involvement — Some patients see similar changes on the soles after water exposure. MDEdge

12. Post-immersion fading — Lesions usually disappear within 10–60 minutes after drying. DermNet®

13. Worse with warm water — Hotter water speeds up and intensifies changes. DermNet®

14. Possible link with excess sweating — Hyperhidrosis may make symptoms more frequent or noticeable. DermNet®

15. Often otherwise well — People with idiopathic AWP are generally healthy; CF-associated cases may have other CF features. JAMA Network

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Diagnostic tests

Doctors usually make the diagnosis from the story and a simple water test. Other tests rule out look-alike problems or check for causes like cystic fibrosis.

A) Physical examination (bedside)

1. Standard skin exam
   The clinician inspects palms (and soles) before and after water exposure, looking for fast wrinkling and translucent papules that fade on drying. This pattern is typical for aquagenic keratoderma. DermNet®

2. “Hand-in-the-bucket” (water immersion) sign
   Hands are immersed in room-temperature water for ~3–7 minutes. In AWP, wrinkling and papules appear quickly; this is a classic sign and helps confirm the diagnosis during the visit. DermNet®+1

3. Dermatoglyphic assessment
   The doctor looks for exaggerated creases and blurred fingerprint lines during immersion; these visible changes strengthen the clinical impression. PMC

4. Distribution mapping
   The clinician notes whether the phenomenon is symmetric, involves thumbs/fingertips, or extends to soles. This helps distinguish AWP from conditions like aquagenic urticaria or contact dermatitis. DermNet®

5. Symptom provocation and relief check
   The doctor asks whether tightness, burning, or itch occurs only while wet and eases after drying—another point toward aquagenic keratoderma rather than a continuous rash. MDEdge

B) Manual/office tests

6. Timed water-immersion test (quantified)
   A stopwatch is used to record the exact time to first papule/wrinkle and time to recovery after drying. Faster onset (often ≤3 minutes) supports AWP and can be tracked over time to judge treatment response. DermNet®

7. Dermoscopy
   A hand-held polarized scope shows accentuated sweat duct openings and whitish edema patterns (e.g., reported “wood-bark sign”). While not essential, it non-invasively documents the changes. Lippincott Journals

8. Minor’s iodine-starch test (for hyperhidrosis)
   If sweating is suspected, iodine plus starch powder turns dark where sweat is heavy. This helps decide whether antiperspirants or botulinum toxin might help. (Hyperhidrosis is a frequent companion.) DermNet®

9. Barrier protection trial (petrolatum or gloves)
   A simple clinic trial—coat one palm with petrolatum or wear a thin glove before immersion. If wrinkling is reduced on the protected side, that supports a water-entry/sweat-related mechanism. (DermNet notes barrier measures, though often only partly helpful.) DermNet®

10. Photographic documentation
    Standardized photos before/after immersion help monitor severity and share findings with other clinicians; many published cases use this approach. American Journal of Medicine

C) Laboratory and pathological tests

11. Sweat chloride test (pilocarpine iontophoresis)
    This is the standard lab test for cystic fibrosis. A high sweat chloride suggests CF or requires further work-up; aquagenic wrinkling is strongly tied to CF. JAMA Network

12. CFTR genetic testing
    If sweat chloride is borderline or if there is a strong family history, CFTR gene testing can look for CF-related variants; several pediatric reports discuss using genetic testing when AWP is present. DermNet®

13. Skin biopsy (punch) with routine stains
    Most people don’t need a biopsy. When done, typical findings include orthokeratosis, acanthosis, spongiosis of the stratum corneum, dilated eccrine acrosyringia, and more capillaries around glands. These findings support the diagnosis and rule out other keratodermas. DermNet®

14. Immunohistochemistry for aquaporin-5 (AQP5)
    In selected, research-level cases, AQP5 staining shows abnormal distribution in sweat glands, backing a water-channel mechanism. This is not routine but appears in the literature. PubMed

15. Basic labs if clinically indicated
    If malnutrition or other skin disorders are suspected, simple labs (e.g., nutrition markers) may be checked; reviews have mentioned malnutrition as a context in some cases. PubMed

D) Electrodiagnostic (sweat nerve) tests

16. QSART (Quantitative Sudomotor Axon Reflex Test)
    QSART measures how the small autonomic nerves that control sweating work by provoking sweat with a tiny current and acetylcholine. It isn’t required for diagnosis of AWP but can characterize sweating in complex or research cases. Cleveland Clinic+1

17. Thermoregulatory Sweat Test (TST)
    This whole-body test maps sweating under heat stress. Like QSART, it is used when doctors need a full autonomic picture rather than for routine AWP confirmation. MedlinePlus

18. Sympathetic Skin Response (SSR)
    SSR records brief changes in skin electrical potential due to sympathetic activity. It’s a general autonomic test and rarely needed in AWP but may be used when evaluating broader dysautonomia. PubMed

E) Imaging-style skin tests

19. Reflectance confocal microscopy (RCM)
    RCM can show swelling of the top skin layer and sweat duct pattern changes during water exposure. It’s non-invasive and has been used in published AWP imaging studies. Karger+1

20. High-definition optical coherence tomography (HD-OCT)
    HD-OCT visualizes broadened, water-swollen stratum corneum and surface pattern changes in AWP. Again, this is a research or specialist tool, not a must-have. Wiley Online Library+1

Non-pharmacological treatments (therapies and practical steps)

Below are practical, non-drug approaches people commonly use. Evidence ranges from expert guidance and case reports to general skin-barrier science; the condition is rare, so large trials are not available. I indicate the purpose and likely mechanism in simple terms.

1. Shorter water contact (timed wet work)
   Description: Keep hand-washing brief, use lukewarm water, and limit soaking. Use tools (tongs, gloves) for wet chores.
   Purpose: Reduce flares.
   Mechanism: Less water exposure lowers the rapid swelling that causes wrinkling and discomfort. This simple step is first-line in reviews and patient guidance. DermNet®

2. Barrier application before water (petrolatum or thick ointment)
   Description: Rub a thin film of petrolatum/occlusive ointment on palms a few minutes before water contact.
   Purpose: Prevent water from entering the outer skin too quickly.
   Mechanism: Occlusives form a temporary seal that slows water and salt movement through the skin surface. This is standard skin-barrier care extrapolated to aquagenic wrinkling. DermNet®

3. Absorbent gloves for chores
   Description: Wear cotton or nitrile gloves during dishwashing/cleaning; switch pairs if damp.
   Purpose: Minimize direct water exposure.
   Mechanism: Physical barrier stops immersion-triggered swelling. Guidance for AWP consistently recommends minimizing water exposure. DermNet®

4. Gentle cleansers, not harsh soaps
   Description: Use fragrance-free syndet cleansers; avoid high-alkali soaps.
   Purpose: Protect the barrier, reduce irritation.
   Mechanism: Mild cleansers reduce stripping of lipids, making the stratum corneum less leaky to water and salts. (General dermatology barrier principles applied to AWP.) DermNet®

5. Lukewarm water instead of hot
   Description: Wash with lukewarm water.
   Purpose: Reduce vasodilation and swelling sensations.
   Mechanism: Cooler water reduces rapid hydration and vasomotor responses that can worsen tingling/tightness. DermNet®

6. After-wash re-occlusion (ointment right after drying)
   Description: Pat dry; immediately apply petrolatum or a ceramide-rich ointment.
   Purpose: Calm tightness and slow re-hydration swings.
   Mechanism: Restores barrier lipids and traps moisture in a controlled way, lowering stimulus for post-immersion papules. DermNet®

7. Hand-care schedule (“cluster” wet tasks)
   Description: Group wet tasks to reduce repeated triggers.
   Purpose: Fewer flares per day.
   Mechanism: Minimizes the number of immersion cycles that provoke wrinkling. DermNet®

8. Antiperspirant routines without prescription drugs
   Description: Over-the-counter antiperspirant sticks/roll-ons used to palms at night (low-strength aluminum salts).
   Purpose: Reduce sweating that may worsen swelling.
   Mechanism: Aluminum salts temporarily block sweat ducts, decreasing eccrine fluid on the surface. (Prescription strengths are in the drug section.) DermNet®

9. Iontophoresis for hyperhidrosis-predominant cases
   Description: Clinic or home devices pass a gentle current through water trays with hands immersed.
   Purpose: Reduce sweating that aggravates aquagenic changes in some people.
   Mechanism: Functionally reduces eccrine gland output; frequently used for palmar hyperhidrosis, sometimes extrapolated for AWP with sweating triggers. PMC

10. Trigger medication review (non-drug step with clinician)
    Description: Ask your clinician to review pain-relievers or other meds if wrinkling began after a new drug.
    Purpose: Remove a possible trigger.
    Mechanism: COX-2 inhibitors (rofecoxib, celecoxib), aspirin, and rarely tobramycin have been linked to aquagenic wrinkling; stopping the trigger can resolve symptoms. PMC

11. Dermoscopic/photographic monitoring
    Description: Take standardized photos after a fixed soak time; some clinics use dermoscopy.
    Purpose: Track response to care.
    Mechanism: Objective tracking helps tailor therapy and is reported useful in case follow-ups. acmcasereport.org

12. CF evaluation when appropriate
    Description: If signs suggest CF (chronic cough, sinus issues, GI symptoms) or strong family history, discuss CF testing.
    Purpose: Detect an underlying cause that also guides treatment.
    Mechanism: AWP is common in CF and carriers; addressing CF (including CFTR modulators) can improve AWP. PMC+1

(Items would continue similar practical measures—workplace accommodations for wet work, moisturizers rich in ceramides, stress reduction if flares correlate with sweating, and protective strategies for swimmers—these are supportive and low-risk but have limited direct AWP-specific trial data.)

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Drug treatments

Because this condition is rare, evidence comes mainly from case reports, small series, and expert reviews. I focus on options with the clearest published support and real-world use. Doses are typical starting points; prescribers adjust for age, comorbidities, and local availability.

1. Aluminum chloride hexahydrate 20% solution (topical, prescription strength)
   Class: Topical antiperspirant. Dose/Time: Apply to dry palms nightly for 1–2 weeks, then 2–3×/week maintenance; wash off in the morning. Purpose: First-line to reduce water-triggered swelling and sweat. Mechanism: Forms temporary plugs in sweat ducts; reduces eccrine output and surface water uptake. Side effects: Irritation or stinging; use on fully dry skin and consider barrier ointment to edges. Evidence: Multiple reports show symptom control; a 2023 idiopathic case responded well; reviews list it as standard initial therapy. PMC+2JAMA Network+2

2. Topical aluminum chlorohydrate emulsion
   Class: Topical antiperspirant. Use: As an alternative when 20% hexahydrate is too irritating. Mechanism & purpose: Same as above, with potentially better tolerability. Side effects: Mild irritation. Evidence: Listed among effective options in therapeutic reviews. ScienceDirect

3. Botulinum toxin type A (intracutaneous injections to palms)
   Class: Neurotoxin reducing cholinergic sweat-gland activity. Dose/Time: Dilution and grid dosing vary by center (e.g., ~50–100 units per palm divided). Effects last ~3–6 months. Purpose: For persistent, hyperhidrosis-linked AWP. Mechanism: Temporarily blocks signals to eccrine glands, lowering surface moisture and wrinkling. Side effects: Injection pain, transient hand weakness, bruising. Evidence: Multiple case reports (including unilateral disease) document success after other measures failed. PMC+1

4. Topical glycopyrronium (cloth/cream)
   Class: Topical anticholinergic. Dose/Time: Once daily to palms, avoiding eyes; off-label in many regions. Purpose: Reduce palmar sweating that worsens AWP. Mechanism: Blocks muscarinic receptors in sweat glands. Side effects: Dry mouth, blurry vision if transferred; use carefully. Evidence: Anticholinergics are standard for palmar hyperhidrosis; extrapolated for AWP in expert reviews. PMC

5. Oral oxybutynin
   Class: Systemic anticholinergic. Dose/Time: Commonly 2.5–5 mg once or twice daily; titrate. Purpose: For significant sweating triggers when topicals fail. Mechanism: Reduces generalized eccrine output. Side effects: Dry mouth, constipation, urinary retention; avoid in narrow-angle glaucoma. Evidence: Established for palmar hyperhidrosis; applied to AWP when sweating is central. PMC

6. Topical urea 20–40%
   Class: Keratolytic/humectant. Dose/Time: 1–2×/day on non-soaked skin. Purpose: Smoother surface, less tightness. Mechanism: Softens thickened stratum corneum and improves barrier water handling. Side effects: Sting on fissures. Evidence: Widely used for palmoplantar keratoderma; included in expert lists for AWP care. PMC

7. Topical salicylic acid 3–6% (keratolytic)
   Class: Keratolytic. Dose/Time: Thin layer nightly; avoid overuse. Purpose: Reduce papule prominence and post-immersion roughness. Mechanism: Breaks down corneocyte cohesion. Side effects: Irritation; not for young children on large areas. Evidence: Reported as adjunct in case series. PMC

8. CFTR modulators (e.g., ivacaftor for qualifying CF mutations)
   Class: Targeted CF therapy. Dose/Time: Per CF protocol. Purpose: In patients with CF and eligible mutations, treating the root ion-channel problem can improve AWP over time. Mechanism: Improves CFTR function and skin ion transport. Side effects: As per CF care. Evidence: Observational data show AWP improvement with ivacaftor. cysticfibrosisjournal.com

9. Topical aluminum lactate or mixed astringent lotions
   Class: Astringents. Use: As gentler alternatives for sensitive skin. Purpose/Mechanism: Protein precipitation reduces surface swelling. Evidence: Listed in therapeutic overviews as options when standard antiperspirants are not tolerated. ScienceDirect

10. Topical barrier-repair creams rich in ceramides
    Class: Emollient/barrier repair. Use: After water contact. Purpose: Improve comfort and reduce post-soak stinging. Mechanism: Replaces lipids; lowers transepidermal water flux swings. Evidence: Barrier-based rationale; commonly recommended adjunct in guidance. DermNet®

11. Topical aluminum chloride at lower concentrations (6–15%)
    Class: Antiperspirant. Use: For those who cannot tolerate 20%. Purpose/Mechanism: Same as 20%, with less irritation. Evidence: Case-based adjustments described in reviews. PMC

12. Topical antiperspirant rotation (alternate nights)
    Class: Treatment strategy. Use: Alternate nights with moisturizer to maintain benefit and limit irritation. Purpose/Mechanism: Preserves sweat-duct plugging while protecting barrier. Evidence: Pragmatic approach described in case-based care. PMC

(Additional drug options beyond these 12 are rarely reported with convincing benefit for AWP. Systemic retinoids and other keratolytics have been tried but carry more risk than benefit for this specific disorder; high-quality evidence is lacking. I avoid recommending them routinely.)

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Dietary molecular supplements

There are no clinical trials showing that any supplement reliably treats aquagenic keratoderma. Supplements may support general skin health, but they should not replace proven topical antiperspirants or botulinum toxin when indicated. Below, I list options sometimes discussed for barrier support; these are adjuncts only and not disease-specific treatments.

• Ceramide-precursor oils (e.g., linoleic acid-rich oils) applied topically help barrier lipids but are cosmetic adjuncts.

• Oral omega-3 fatty acids may modestly reduce skin inflammation in general populations.

• Vitamin D supports overall skin immunity; use only if deficient.

• Biotin has no proven role in AWP; avoid high doses without deficiency.

• Niacinamide (topical) can aid barrier function; oral forms may flush.
  (Given the lack of AWP-specific evidence, I won’t pad this section with speculative claims.)

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Immunity booster / regenerative / stem-cell drugs

There is no role for immune boosters, regenerative drugs, or stem-cell therapies in aquagenic keratoderma. The disorder is a local skin/water-sweat interaction problem, not an immune-deficiency or stem-cell disease. Using these would add cost and risk without proven benefit. PMC

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Surgeries

Surgery is not part of standard care for aquagenic keratoderma. Because symptoms are triggered and reversible after drying, and because effective non-surgical options exist (antiperspirants, botulinum toxin), surgery is not recommended. Older surgical options used for severe hyperhidrosis (such as endoscopic thoracic sympathectomy) are not indicated for this condition and carry meaningful risks (compensatory sweating, pneumothorax). PMC

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Prevention tips

1. Keep hand-washing brief; use lukewarm water. DermNet®

2. Apply a thin film of petrolatum before predictable water exposure. DermNet®

3. Wear protective gloves for wet chores; change if damp. DermNet®

4. Use gentle, fragrance-free cleansers. DermNet®

5. Pat dry; immediately apply a ceramide-rich ointment. DermNet®

6. Start nighttime antiperspirant routines on fully dry skin. JAMA Network

7. Cluster wet tasks to reduce repeated immersion cycles. DermNet®

8. Review new drugs (especially COX-2 inhibitors, aspirin) with your clinician if symptoms began after starting them. PMC

9. If you have strong symptoms or a family history suggesting CF, ask about CF evaluation. PMC

10. Consider clinic options (iontophoresis or botulinum toxin) if home measures fail. PMC

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When to see a doctor

• If your palms wrinkle painfully within minutes of water exposure, especially if this is new or severe.

• If you or your child has other features suggestive of cystic fibrosis (chronic cough, recurrent sinus/chest infections, steatorrhea, poor weight gain) or a family history—testing may be appropriate.

• If over-the-counter measures (barrier ointment and gentle antiperspirant use) don’t help after 2–4 weeks.

• If you notice wrinkling starting soon after a new medication (especially celecoxib, aspirin, or similar) so your clinician can review alternatives. DermNet®+2PMC+2

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What to eat and what to avoid

There is no special diet proven to treat aquagenic keratoderma. Eating patterns do not change the rapid, water-triggered skin swelling that defines this problem. Focus on a balanced diet for general skin and health: fruits, vegetables, adequate protein, and hydration as per normal needs. Avoid extreme dehydration; it will not prevent wrinkling episodes and may harm health. Be cautious with unproven “skin supplements” marketed for keratoderma—there is no disease-specific evidence. PMC

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Frequently asked questions

1) Is aquagenic keratoderma dangerous?
No. It is uncomfortable but not dangerous by itself. The main medical importance is its link with cystic fibrosis in some people. DermNet®

2) Does the skin change permanently?
No. The white, swollen look appears within minutes of water contact and fades after drying. DermNet®

3) Can it affect the feet?
Yes, palms are most common, but soles can be involved. PMC

4) Why is it tied to cystic fibrosis?
CFTR changes alter salt and water transport in skin, which seems to speed wrinkling after water contact. The Lancet

5) Will treating cystic fibrosis help the palms?
In people with eligible CF mutations, CFTR modulators such as ivacaftor have been associated with improvement over time. cysticfibrosisjournal.com

6) What is the best first treatment?
Nightly 20% aluminum chloride (if tolerated) plus water-exposure control is a common first step. JAMA Network

7) What if aluminum chloride stings?
Try lower strengths or switch to aluminum chlorohydrate emulsion; protect with ointment and apply only to fully dry skin. PMC+1

8) Do antiperspirants cure it?
They control symptoms by reducing sweat and surface water; effects last only while used. JAMA Network

9) When is botulinum toxin considered?
For persistent, bothersome cases, especially with sweating triggers, after simpler steps fail. PMC

10) Are there pills that help?
Anticholinergic pills like oxybutynin may help when sweating is a major driver, but side effects limit use. PMC

11) Which medicines can cause aquagenic wrinkling?
Reports link COX-2 inhibitors (rofecoxib, celecoxib), aspirin, and rarely tobramycin. Tell your clinician if symptoms started after one of these. PMC

12) Can I test this at home?
A brief soak test shows changes, but formal diagnosis and management planning should be done by a clinician. DermNet®

13) Is it the same as aquagenic urticaria or aquagenic pruritus?
No. Those conditions cause hives or itch after water; aquagenic keratoderma causes wrinkling and papules without hives. DermNet®

14) Does it go away?
It can fluctuate. Some people improve with careful routines or after stopping a trigger drug. PMC

15) What’s the outlook?
Good. Most people can control symptoms with barrier strategies, antiperspirants, and (if needed) botulinum toxin. DermNet®+1

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: September 21, 2025.

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