Wrinkling and painful skin of the hands after shower or bath

Question

Hello,
My son has always had very quickly fripent fingers, with strong tingling, pain and even cracks. His skin becomes white and granular and may even goes in powder if he rubs his hands. It's more or less pronounced according to times / periods. It makes me too, like almost everybody. We are not talking about the same rapidity of onset, nor of the same magnitude. You will find below two studies that describe it as a marginal phenomenon, nevertheless I personally think it is far more widespread than originally believed. The two key passages:
"Ultimately, the CF should be suspected in patients with wrinkles aquagenic the palms of the hands, and patients with cystic fibrosis should be questioned about this symptom."
"Similarly, diabetes, leprosy and Other Disorders Affecting The Nerves May Not Develop Skin wrinkles Because Of Their condition while Those With Cystic Fibrosis Have Been Shown to Develop Quicker Such wrinkling."

First study:
Aquagenic wrinkles of palms in patients with cystic fibrosis homozyogotes for the mutation delta F508 CFTR. Arch Dermatol, 2005, 141.5 :621-624. Katz KA, et al.
Aquagenic wrinkles of palms are a rare phenomenon characterized by rapid and transient formation of white plaques, edema on the palms of the hands when in contact with water, and these changes may be asymptomatic or accompanied by feelings of itching or burning.
Described for the first time in patients with cystic fibrosis, the phenomenon was first observed in women; specific mutations in the CFTR gene were not detected in these subjects.
The article describes the cases of 2 patients homozygous for delta F508 mutation:
- A boy of 17 years (male first case described), who presented wrinkles aquagenic for 3 years.
- A 13 year old boy who presented this phenomenon for 6 months.
Ultimately, the CF should be suspected in patients with wrinkles aquagenic the palms of the hands, and patients with cystic fibrosis should be questioned about this symptom.
Although the etiology is unknown, the association with cystic fibrosis and inhibitors of cyclooxygenase-2 suggests that skin exposure to high concentrations of salt may play a role in its pathogenesis.

Second study (At the very end of the text, it is mentioned that Mucos wrinkle faster in water):
Why Does Skin Wrinkle in Water?
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Overview
Most Likely you've Noticed your fingertips When you come out of the pool or bathtub after a long soak: They are wrinkled, so Much More Than When You Went in. Yet, soon after you dry off, They return to normal. This Is part of a complex process to keep your skin moist and flexible am and is related to The Reason MOST People Need to Apply moisturizing lotion or oil.
Layers
The Skin Is Made up of SEVERAL layers. The top layer Is The stratum corneum - Which in Latin means clustering Simply horny layer. This IS particularly thick layer at your fingertips and toes. This Is the layer flakes off and May That APPEAR have dandruff and Appearance in your bed linens, clothes and in your Elsewhere.
Sebum
To CounterAct The flaking, your epidermis, outer layer The hand of skin, producer sebum. Sebum Is A Protein That Repels water. However, When You Are In The Tub, scrubbing away the dead cells are your statum corneum, you also soak away Some Of The sebum. Malthus your skin can not repel the Water Before and so did it swells up, Especially in your toes and fingers. You do not notice this swelling Because You are Surrounded by fluids.
Evaporation
When You Get Out of the Tub, The excess water evaporate Quickly, however, It Takes along your skin to shrink back to original appearance icts. At this point, your Skin Is particularly dry Because it Does not Have As Much sebum, so it's a good idea to use moisturizer for Added Protection For Your Skin.
Saltwater
Interestingly enough, wrinkling May Not Happen If You are in saltwater. According To Grace Fields at Argonne National Laboratory, The Water is saltier if Than Your Skin, It Will draw water out of your skin. If The Water is less salty, your skin absorb the Water Will it around. This Is Because water travels From The Areas With The least salt concentration to Those With The Highest salt concentration. The water in saltier Than Your Body Is fresh water, hence The wrinkles.
Nerve Damage
When There Is Nerve Damage In The Gold Fingers toes, The Skin Does not wrinkle in water. When nerve damage has been "That Repaired, The Skin wrinkling reoccurs, at least in part. Many Hospitals and Other Medical Facilities check for nerve damage by submerging in water The body part and checking for wrinkling, According to Gregory Borah, MD, in a letter to "Discover" magazine.
Similarly, diabetes, leprosy and Other Disorders Affecting The Nerves May Not Develop Skin wrinkles Because Of Their condition while Those With Cystic Fibrosis Have Been Shown to Develop Quicker Such wrinkling.

The questions are:
- What is the exact mechanism?
- What case occurrence?
- How to relieve?
Thank you in advance, Sincerely,

Answer

Hello,
You ask a question to that you make an answer very well supported by the references you quote. So have I little evidence to bring to complete your information.
The symptoms you describe have indeed been reported in a few publications under various names: Aquagenic palmoplantar keratoderma (APPK), also called Aquagenic wrinkling of the palms, Transient reactive papulotranslucent acrokeratoderma, Aquagenic syringeal keratoderma or Transient aquagenic hyperwrinkling ... For diagnosis, it can easily be caused by the immersion of hands in a bucket of fresh water (cold or warm) for 3 minutes. This test aims to highlight what is called simply the "Sign of the bucket. This dermatosis is characterised by oedema, whitish papules, hyperwrinkling and sometimes desquamation of palms and/or soles. It appears after contact with water for a few seconds to ten minutes; however, symptoms most often present after two to three minutes of water immersion. It can also trigger pruritus, tingling, burning or even pain.
These symptoms have been observed for the first time in a patient with cystic fibrosis in 1970. Fifty identical cases have been reported so far. This symptomatology is not related to the severity of the disease since it can be found in healthy carriers of a single mutation of the CFTR gene or in individuals with no CFTR mutation. The sign of the bucket was positive in 11 of 27 patients with cystic fibrosis (41%), in a recent study carried out in our center and published in 2010 in the British Journal of Dermatology. It is therefore a usual sign of cystic fibrosis whose frequency is very underassessed because the attention of teams and patients is primarily focused towards more severe symptoms. This symptom is the manifestation of an increase of salt (sodium and chlorine) concentration in the different layers of the skin resulting in water hyperabsorption.This pathophysiological mechanism explains the symptoms can be observed also in other medical conditions than cystic fibrosis or as a side effect of some drugs that inhibit cyclo-oxygenase 2 (rofecoxib, Relecoxib and Aspirin).
Usually light, this symptom may sometimes be perceived as unpleasant or a fortiori painful. Then, it can be improved by avoiding predisposing conditions (occlusion by hands gloves, inhibitors of cyclo-oxygenase 2), and with application of moisturizers.
With my cordial greetings.

Gilles Rault

Reference quoted : Frequency of aquagenic Palmoplantaris keratoderma in cystic fibrosis: a new sign of cystic fibrosis? Br J Dermatol, 2010 Jul; 163 (1) :162-6. Male N-Michel et al.

03.05.2011