Abstract
Aquagenic keratoderma is an underdiagnosed entity. Two forms have been described: hereditary and transient reactive. This condition has different names; aquagenic syringeal acrokeratoderma, aquagenic palmoplantar keratoderma, or transient aquagenic palmar hyper wrinkling. We present a case of palmar aquagenic keratoderma in a 14-year-old female with a complex medical history including diabetes, psoriasis, arthritis, and epilepsy. The patient started to have water-induced skin changes in her hands several years ago. A previous biopsy of her right hand was nonspecific. She denies chronic sweating on the palms. When the patient’s hands were exposed to water for 5 minutes, they started to develop stabbing pain pruritus, and immediate sloughing of skin. Due to the patient’s quality of life issues related to this condition, a water immersion test was done in our institution on the right hand. A control biopsy of the opposite hand was obtained at the same time. The control biopsy shows no diagnostic abnormalities. The right-hand punch biopsy after water immersion shows compact orthokeratosis with hyperkeratosis and slight dilatation of dermal vasculature. An inflammatory cell infiltrate is not observed. It is necessary to continue reporting these cases to avoid any diagnostic pitfalls, understand the disease, and establish certain clinical, dermoscopic, and histopathological criteria trying to improve the patient's quality of life and provide adequate management. Comparison between the pre and after-water biopsies could be a leading point in the diagnosis.