What are those white spots?

This 18-year-old male presented for evaluation of white spots appearing on his palms after being in water that lasted up to 30 minutes. He is otherwise healthy.

What is this condition? What, if anything, is associated with it?

A. Aquagenic syringeal acrokeratoderma.

B. Aquagenic wrinkling.

C. Aquagenic whitening.

(Answer and discussion on next page.)

ANSWER—Case 3: Aquagenic syringeal acrokeratoderma

While there are no associations with this condition, it must be distinguished from aquagenic whitening (and wrinkling) of the palms, which is associated with cystic fibrosis. Unfortunately, aquagenic syringeal acrokeratoderma is not a well understood condition.¹ ■

Reference:

1.Itin PH, Lautenschlager S. Aquagenic syringeal acrokeratoderma (transient reactive papulotranslucent acrokeratoderma). Dermatology. 2002;204(1):8-1.