Aquagenic wrinkling of the palms (transient aquagenic palmar hyperwrinkling, TAPH) is an uncommon skin reaction following immersion in water. It is usually associated with some form of cystic fibrosis and may be the reason for presentation.


Clinical features:

(1) swelling and hyperwrinkling of the palms following immersion for a few minutes in water

(2) burning sensation

(3) variable hyperhidrosis

(4) reversal after removal from the water (transient)


Conditions associated with aquagenic wrinkling:

(1) mild to severe cystic fibrosis (wrinkling that appears within 2-3 minutes is seen in homozguous disease)

(2) atypical or variant form of cystic fibrosis

(3) exposure to certain drugs (aspirin, rofecoxib, tobramycin)


The diagnosis of drug-induced aquagenic wrinkling requires a clear temporal association with drug exposure AND exclusion of all forms of cystic fibrosis.


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