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( Image credit: Image thanks to JAMA Network Ⓡ. © 2025 American Medical Association.)
The client: A male in his 20s in China
The signs: A male went to the dermatology department of a health center after experiencing an
range of signs for about 3 years. When he immersed his hands in water, such as throughout hand-washing, the skin on the back of the guy’s hands thickened and ended up being excessively wrinkly, with white bumps and developments appearing.
The guy had actually formerly looked for treatment at his regional center, where he was identified with persistent eczema — which triggers skin to end up being dry, thick and scratchy– and recommended a strong retinoid lotion, which he utilized periodically. This treatment didn’t work, and his signs slowly got worse. His wrists and elbows had actually likewise begun to establish the skin sores over the 1.5 years prior to the health center check out.
The client had no household history of comparable skin problem and did not experience extreme sweating or have any allergic reactions, and he had actually never ever hurt his hands. The male associated the worsening of his condition to him cleaning his hands more regularly throughout the COVID-19 pandemic, the medical professionals composed in the report of the case
What took place next: Throughout a physical exam at the medical facility, the guy’s hands were immersed in water for 10 minutes, instantly triggering the tops of his hands, fingers and wrists to grow red, flaky and wrinkly with white sores. Significantly, the “excessive wrinkling” and bumps ended in a straight line on the sides of his hands, leaving his palms untouched.
The physicians took biopsies from the white bumps on his right-hand man, which exposed that the sweat ducts in the leading layer of skin had actually broadened and included more gland than regular. The outcomes likewise revealed he had hyperkeratosissuggesting his body was producing excessive of the protein keratin, triggering the external layer of skin to thicken.
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The medical group composed that “the patient’s clinical process was quite interesting,” since the signs of the skin problem appeared just after his hands were immersed in water and all signs vanished around 30 minutes after his hands dried.
Biopsies of the white bumps on the male’s hands (amplified above)revealed the sweat ducts on the surface area of his skin were unusually broad. (Image credit: Image thanks to JAMA Network Ⓡ. © 2025 American Medical Association. )The medical diagnosis: The physicians detected the client with a condition called aquagenic syringeal acrokeratoderma (ASA) based upon how his signs appeared in the center and the outcomes of the biopsy. In practically all other cases, nevertheless, it impacts the palms of the hands, not the backs of the hands or fingers.
The brief signs of this skin illness are called the “hand in the bucket sign,” since they happen after the hands are immersed in water. The signs generally vanish within a couple of hours of drying, however a subset of individuals with ASA have relentless skin sores that are exacerbated by water direct exposure, according to the Hereditary and Rare Diseases Information Center (GARD).
The reason for ASA is presently unidentified, however it might be connected to “an acquired sweat gland abnormality” or some trigger that triggers thickening of the skin, according to research study released in the Journal of the American Academy of Dermatology
The treatment: The client was treated with topical hydrocortisone urea lotion, which is a corticosteroid and skin moisturizer that can be used straight to the afflicted location. It is normally utilized to deal with skin inflammation, swelling and soreness.
The medical professionals likewise suggested that the client prevent getting his hands damp more than what was strictly essential. The male was still going to follow-up consultations when the medical professionals discussed his case, and they kept in mind that his signs had actually reduced considerably after simply one month.
What makes the case distinct: ASA is believed to be an uncommon condition, although its specific frequency is unidentified.
Information recommends the condition is most typical in female teenagers, the case report authors kept in mind. It likewise happens in about 40% to 84% of cystic fibrosis (CF) clients and providers, suggesting individuals who have simply one copy of the CF gene anomalyaccording to GARD. (You require 2 copies to establish CF.) This pattern mean ASA being triggered in part by anomalies because gene, a minimum of in many cases.
The client explained in this case was the very first understood to have ASA that didn’t impact his palms, the medical professionals composed in the report. It’s uncertain why his case manifested in a different way than others formerly reported.
For more appealing medical cases, have a look at our Diagnostic Dilemma archives
This short article is for informative functions just and is not indicated to use medical recommendations.
Sophie is a U.K.-based personnel author at Live Science. She covers a vast array of subjects, having actually formerly reported on research study covering from bonobo interaction to the very first water in deep space. Her work has actually likewise appeared in outlets consisting of New Scientist, The Observer and BBC Wildlife, and she was shortlisted for the Association of British Science Writers’ 2025 “Newcomer of the Year” award for her freelance work at New Scientist. Before ending up being a science reporter, she finished a doctorate in evolutionary sociology from the University of Oxford, where she invested 4 years taking a look at why some chimps are much better at utilizing tools than others.
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