Water-induced white papules: A case series of 12 patients with aquagenic syringeal acrokeratoderma

Aquagenic syringeal acrokeratoderma (ASA) is a rare, transient skin disorder characterized by the appearance of white papules and plaques on the palms after short-term exposure to water. We report a two-year case series involving 12 patients (8 males, 4 females) aged 7 to 32 years (mean age 19.25), all diagnosed with ASA. Symptoms developed within 1-6 min of water contact and resolved spontaneously within 20-52 min. Palmar involvement was present in all cases, without lesions on the fingertips, dorsal hands, or plantar surfaces. Diagnosis was made clinically in 10 patients and histopathologically confirmed in two. Seven patients reported symptoms, including itching, burning, or hyperhidrosis, whereas five remained asymptomatic. None had relevant medication use, recent viral illness, or known genetic predisposition, such as cystic fibrosis. Topical therapies provided partial relief; however, recurrence was common during the follow-up period. This study highlights the characteristic clinical presentation of ASA, the importance of clinical recognition, and the challenges in achieving sustained treatment success.