Aquagenic keratoderma with no palmar involvement and no complete resolution after drying: an unusual clinical presentation

Aquagenic keratoderma (АK) is a rare benign skin disorder consisting in a transient reactive papulotranslucent acrokeratoderma, aquagenic wrinkling of the palms or aquagenic syringeal acrokeratoderma. A 9 years old Caucasian girl, born out of nonconsanguineous marriage, suffering from ADHD (Attention Deficit Hyperactivity Disorder), presented a hyper-wrinkling of all the ventral aspects of the distal phalanges and whitish-erythematous plaques in correspondence with the metacarpophalangeal joints after immersion in water (15°C for 15 seconds); after the skin drying (30 minutes), eroded erythematous plaques on the fingers persisted. Curiously, no palmar involvement was observed. No familiar history was noted, no actual use of medications was reported.