Aquagenic Wrinkling of Palms

Question

Hello,
My dermatologist diagnosed me an Aquagenic Wrinkling of Palms: does it necessarily mean that I have cystic fibrosis?

Regards.

Answer

Hello,
The Aquagenic Wrinkling of Palms (AWP) is a skin manifestation which can be detected by the so called bucket test. It consists of dipping the hands in a bucket of water (cold or warm) for 3 minutes: it is positive when it reveals an accentuation of the folds of the palms accompanied by swelling and a feeling of tingling more or less inconvenient and sometimes painful.

This syndrome can have several causes. Cystic fibrosis (CF) is the most common. Some clinical studies after the first description show a frequency of approximately 75% in People With Cystic Fibrosis (carrying two mutations of the CF gene, CFTR) and 25% of carriers of a single mutation (not CF and known as healthy carriers : about 2 million people in France).

Very rare cases have been reported related to certain medications: ACE inhibitor, inhibitor of cyclooxygenase, nonsteroidal anti-inflammatory drugs.

This syndrome can also be "idiopathic" ie isolated not related to a particular disease (that the case of the AWP in the healty carriers of a single CFTR mutation). Its frequency in the general population, not precisely known, is low but probably underestimated.

If troublesome symptoms are there, it can be treated by aluminum salts.
To return to your question, the answer is no: the fact that you were diagnosed with an Aquagenic Wrinkling of Palms does not necessarily mean you are suffering from CF. It would be reasonable to perform additional tests if you have other CF suggestive symptoms: bronchial or ENT recurrent respiratory infections, chronic diarrhea, malnutrition characterized by relative low weight for height (lowered body mass index). Confirmation of CF diagnosis is then based on the positivity of the sweat test and / or the identification of two mutations in the CFTR gene in a blood sample.
You can have more information by clicking on the following links:

Please find more information on this platform in former questions about AWP.

Hop this answer can help.
Best wishes
Gilles RAULT, MD, Roscoff CF Center

15.09.2015