Acquired Aquagenic Syringeal Keratoderma Following COVID-19 Infection.

Publication date: Mar 04, 2024

Aquagenic syringeal keratoderma (ASK), rare in males, is characterized by the rapid onset of edematous palmar wrinkling with small white papules after brief contact with water or sweat. A 24-year-old atopic male presented with a 2-week subacute history of bilateral palmar edema with whitish-colored papules after exposure to water, 3 months after having had COVID-19 infection treated with a full course of ritonavir-boosted nirmatrelvir (PAXLOVID). He had received 3 COVID-19 vaccines (Pfizer, New York, NY) about 12 months prior. Workup was negative. Initial spontaneous near-resolution 2 months after onset was temporary, with recurrence 1 month later. Treatment with 12% topical aluminum chloride was ineffective. Botulinum toxin injection to both palms led to resolution of symptoms that has been sustained for 7 months. The association between atopy and ASK remains weak. We present a case of new-onset ASK in an adult male 3 months following COVID-19 infection without a history of excessive handwashing. Our patient may have had a predisposition to recurrent ASK due to his history of atopy including atopic dermatitis and food allergy anaphylaxis combined with prior COVID-19 infection. It is possible that ASK is a novel manifestation of post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PASC) infection or long COVID.

Concepts Keywords
Aquagenic aquagenic syringeal keratoderma
Coronavirus aquagenic wrinkling
Dermatitis ASK
Handwashing botulinum toxin
Old COVID-19
hand wrinkling


Type Source Name
disease MESH COVID-19
disease MESH Infection
drug DRUGBANK Water
disease IDO history
disease MESH edema
drug DRUGBANK Ritonavir
drug DRUGBANK Aluminum chloride
disease VO ineffective
disease VO injection
disease MESH atopic dermatitis
disease MESH food allergy
disease MESH anaphylaxis
disease MESH sequelae
disease VO Severe acute respiratory syndrome coronavirus 2
disease MESH long COVID

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