Aquagenic Syringeal Acrokeratoderma

improved to baseline status within 30 to 45 minutes. Based on clinical symptoms resembling aquagenic syringeal acrokeratoderma, we performed a histological study that revealed mild hyperkeratosis and discrete dilatation of the acrosyringium, of unclear pathological significance (Figure 2). Because the symptoms were similar to the alterations described at the palmarplantar level in patients with cystic fibrosis,13 we performed a sweat test, which was normal. The patient was started on topical treatment with an 18% aluminum hydrochloride water-alcohol solution but showed no significant improvement. He declined to participate in a therapeutic trial with botulinic toxin.14 We describe this case study in order to extend the body of literature on this new entity in Spain and express our opinion that this disease may have been underdiagnosed to date.