Unilateral aquagenic keratoderma treated with botulinum toxin A

Abstract

Background: Aquagenic keratoderma is a rare transient disease that occurs after water immersion and disappears shortly after drying. Most cases involve the palms and fingers bilaterally but it can also affect the soles. Few cases have been associated with drugs but its pathogenesis remains unclear.

Main observation: We report a 60-year-old man with a 30-year-history of aquagenic keratoderma of the right palm without associated hyperhidrosis or history of drug intake. After unsuccessful treatment with 15% aluminium chloride hexahydrate gel, botulinum toxin A injections led to significant improvement within 2 weeks.

Conclusions: To our knowledge, this case is the first report of idiopathic unilateral aquagenic keratoderma in the medical literature. It is the third report of successful treatment with botulinum toxin A which is in favor of a role of sweat glands in the pathogenesis of aquagenic keratoderma.

Keywords: aluminium chloride; hyperhidrosis; keratoderma; wrinkling.

Figure 1

Confluent whitish papules on the right palm after 5 minutes of immersion of the hands in tap water.

Figure 2

Significant improvement of the right palm after immersion of the hands in tap water after 2 weeks of treatment with botulinum toxin injections.