Aquagenic wrinkling of the palms (AWP) describes a temporary skin phenomenon where the palms, and sometimes soles, develop excessive and rapid wrinkling and whitening after brief water exposure. This noticeable change is distinct from typical skin responses to water.
Understanding Aquagenic Wrinkling
Aquagenic wrinkling of the palms is characterized by the rapid onset of pronounced, raised, white or translucent wrinkles and papules on the affected skin. This can appear within minutes, often as quickly as three minutes, of water contact. Many individuals also report a sensation of tightness, mild itching, or sometimes burning or tingling in the affected areas.
This reaction differs significantly from the normal, temporary wrinkling that occurs after prolonged water immersion, which typically takes around 11 minutes to appear. AWP’s speed of onset and more exaggerated appearance are key distinguishing features. While most commonly affecting both palms symmetrically, the soles of the feet can also be involved, and in rare instances, other areas like the forehead or heels might show signs. The wrinkling usually resolves within 10 to 60 minutes after the skin dries.
Associated Conditions
While aquagenic wrinkling of the palms can sometimes occur without an identified underlying cause, known as idiopathic AWP, it is most notably and strongly associated with cystic fibrosis (CF). Up to 80% of individuals with cystic fibrosis and up to 25% of carriers of the CF gene may experience AWP. The mechanism in CF patients is believed to involve issues with eccrine sweat duct function, possibly due to mutations in the CFTR gene, which can lead to altered salt balance in skin cells and increased water retention.
Other, less common associations for AWP have been reported in medical literature. These include certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or rofecoxib, and some antibiotics. These drug-induced cases might relate to dysregulation of aquaporin, a protein involved in water transport across cell membranes. Conditions like hyperhidrosis (excessive sweating), Raynaud disease, marasmus, and atopic dermatitis have also been mentioned in connection with AWP, though these links are far less prevalent than the association with cystic fibrosis.
Assessing the Risk
The physical changes are temporary and resolve without lasting damage once the skin dries. The primary significance of AWP lies in its potential as a subtle indicator of an underlying systemic condition, particularly cystic fibrosis. The presence of AWP can serve as a diagnostic clue, prompting further investigation. However, if the condition is newly noticed, persistent, or occurs alongside other symptoms, it warrants consideration for further evaluation.
What to Do Next
If you notice aquagenic wrinkling of your palms, particularly if it’s a new occurrence, is persistent, or is accompanied by other health concerns, consulting a healthcare professional is recommended. This is especially important if symptoms such as a chronic cough, recurrent respiratory infections, or digestive issues are also present, as these could suggest an underlying condition like cystic fibrosis. A doctor can evaluate your specific symptoms, take a comprehensive medical history, and determine if further diagnostic testing is appropriate.
Such testing might include a sweat chloride test, which is a common and reliable method for screening for cystic fibrosis. For cases where AWP is determined to be idiopathic (without a known underlying cause), management typically focuses on avoiding prolonged water exposure. Additionally, emollients or certain topical treatments like aluminum chloride solutions may be suggested to help manage the symptoms, as there is no specific “cure” for the phenomenon itself.