Palm showing aquagenic wrinkling with water splashing behind it

Why Are My Hands so Wrinkly?

Everyone has experienced hand and feet wrinkling at some point in their life. When we are young, we quickly learn that if we submerge our hands and feet in water for too long, our palms and feet turn rather pruney in appearance. This is because our body sends a message to our nerves to signal submergence in water, causing blood vessels to shrink. When blood vessels shrink, they deflate, causing the skin to also deflate. This produces the wrinkling or the pruney effect we commonly know.

Wrinkling, however, can be more pronounced in people with CF. It even has a special name: aquagenic wrinkling. Up to 80% of people with cystic fibrosis experience aquagenic wrinkling of the palms.1

What is aquagenic wrinkling of the palms?

Aquagenic wrinkling was only first described in literature in the year 1974.1 It is characterized by a rapid formation of swollen, white plaques on the palms and soles when exposed to water. This is different than wrinkling that happens in people without CF because it is quite rapid in nature -- we are talking as quick as within 2 minutes of water contact! In some people with CF, aquagenic wrinkling also involves itchiness and a burning sensation.1

What causes it?

The exact cause is unknown at this time. However, it is proposed to be a result of abnormal electrolyte movement. Some people find that they only get this reaction with tap water, but not saltwater, and often, hot water worsens the wrinkling. In some other cases, aquagenic wrinkling may be a side effect of drugs, such as nonsteroidal anti‐inflammatory agents, such as ibuprofen, or angiotensin inhibitors used to treat high blood pressure.1

Does it get better?

Yes; the wrinkling is temporary in nature and resolves within 10-60 minutes of drying. However, the swollen plaques can take hours to resolve. Often, the condition improves as people get older as well.1

Can it be treated?

There is no curative treatment, and there isn’t a specific drug developed to address the underlying issue. Fortunately, aquagenic wrinkling itself doesn't cause harm beyond the discomfort. Some treatment options include:2

  • Application of antiperspirant composed of 20% aluminum chloride to the palms at night
  • Bathing in salt water
  • Botox injections
  • Taking antihistamines such as Reactine prior to bathing

A diagnostic clue

Studies have shown that it is not just people with CF who have aquagenic wrinkling of the palms; people who are CF carriers can experience it as well. There are case studies of people who presented with wrinkling upon water contact, and upon further investigation by their doctors, were found to have a heterozygous mutation in the cystic fibrosis transmembrane conductance regulator gene (CFTR).3 The current recommendation is to perform genetic testing in people who present with complaints of wrinkling because it can be indicative of a CF diagnosis.

Aquagenic wrinkling and COVID-19

There are recent reports of people presenting with complaints of aquagenic wrinkling, yet are not CF carriers or have a CF diagnosis. This was found to be the result of frequent hand-washing and sanitizing due to COVID-19.4 It is a good reminder that it is important to restore skin barrier function by using good quality hand moisturizers, and that excessive use of ethanol can trigger these reactions.

Have you experienced aquagenic wrinkling of the palms, and if so, does it bother you either cosmetically or symptomatically? Share your experiences below!

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