key: cord-0061180-8zz6d9gg
authors: Ayhan, Erhan; Yıldırım, Cihat; Aksoy, Mustafa; Ebik, Berat; Öztürk, Murat; Akelma, Hakan
title: Ten cases of aquagenic syringeal acrokeratoderma revealed during the COVID‐19 outbreak
date: 2021-02-23
journal: Int J Clin Pract
DOI: 10.1111/ijcp.13914
sha: 3845bcac67f83ed8d6151a0791d2817405dc5dc5
doc_id: 61180
cord_uid: 8zz6d9gg

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exactly, it has been suggested that the disease may develop due to genetic predisposition or diseases such as cystic fibrosis, focal hyperhidrosis and Raynaud's phenomenon. 2, 3 However, increased personal hygiene measures such as wearing personal protective equipment, excessive hand washing and disinfection in the COVID-19 epidemic may play a role in the aetiology of ASA. 5 Here we present ten cases with a very short history of ASA where lesions were first seen after the COVID-19 outbreak.

The ages of the patients varied between 5 and 24 years (6 female, 4 male). The duration of disease was between 20 days and 2 months.

Lesions of all patients were occurred by continuous water contact Table 1 .

In the pathogenesis of aquagenic syringeal acrokeratoderma, the increase in the water-binding capacity of epidermal keratinocytes due to the increase in epidermal sodium concentration has been accused. 2 The aetiology of the disease is not fully known.

However, in the COVID-19 pandemic, hygiene practices are carried out excessively. According to a recently published case reports, it was evaluated that ASA was formed as a result of excessive and prolonged water contact during the COVID-19 pandemic. 4, 5 Due to the COVID-19 epidemic, 70 percent of our patients was washing their hands frequently and were in frequent contact with the disinfectant. In addition, it was thought that the fact that at least one of the parents of 70% of the cases was a healthcare worker, strict hygiene measures were followed and this could lead to the development of ASA.

Most cases are sporadic and acquired, but familial cases with significant female dominance have also been reported.. 6 The fact that there are three siblings (6 patients in total) among our cases shows that ASA also has a genetic tendency.

Treatment options include topical aluminium chloride, glycerol, salicylic acid, urea and ammonium lactate creams, iontophoresis and botulinum toxin. 4 The vast majority of our cases were left untreated, and their lesions largely regressed with the reduction in water contact.

As a result, although there are discussions on the pathophysiology of ASA, we think that the implementation of long-term and strict hygiene rules in the COVID-19 epidemic contributes to the emergence of ASA. In addition, the fact that 60% of the cases are siblings suggests that the disease has a genetic predisposition.

The authors have declared no conflicts of interest for this article.

Not applicable.

Erhan Ayhan. 

Acquired aquagenic syringeal acrokeratoderma: a case series of 10 patients

Aquagenic keratoderma. two new case reports and a new hypothesis

Aquagenic wrinkling of the palms in cystic fibrosis and the cystic fibrosis carrier state: a case-control study

Aquagenic syringeal acrokeratoderma from extensive water immersion during the COVID-19 pandemic outbreak

Frequent handwashing and disinfection: a potential new trigger for aquagenic wrinkling of the palms caused by COVID-19 outbreak

Familial aquagenic acrokeratoderma: case reports and review of the literature