Aquagenic Keratoderma: Treatment Update

Actas Dermosifiliogr. 2022 Mar;113(3):254-260. doi: 10.1016/ Epub 2021 Jun 12.
[Article in English, Spanish]


Aquagenic keratoderma is an uncommon acquired dermatosis characterized by edema and whitish-translucent papules triggered by immersion or contact with water. Cases have been described in association with certain medications, hyperhidrosis, and cystic fibrosis. The aim of this review is to evaluate the effectiveness of different treatments for aquagenic keratoderma. We reviewed the literature and analyzed treatments for aquagenic keratoderma described in case series and reports. Aquagenic keratoderma associated with hyperhidrosis can be treated effectively. Tap water iontophoresis, endoscopic thoracic sympathectomy, botulinum toxin injections, and oxybutynin are effective against refractory forms. Topical salicylic acid and aluminum salts are effective, but of little value as maintenance therapy. Oral oxybutynin 5 mg/d is probably the best option for treating aquagenic keratoderma. The reported pathophysiological effects of nonsteroidal anti inflammatory drugs in this setting suggest that the use of prostaglandins might be justified. Additional studies are needed to investigate these hypotheses and resolve other questions.

Keywords: Anti cholinergics; Anti-colinérgicos; Aquagenic keratoderma; Botulinum toxins; Hiperhidrosis; Hyperhidrosis; Queratodermia acuagénica; Toxina botulínica.

Publication types

  • Review

MeSH terms

  • Anti-Inflammatory Agents, Non-Steroidal
  • Humans
  • Hyperhidrosis* / drug therapy
  • Hyperhidrosis* / etiology
  • Keratoderma, Palmoplantar* / drug therapy
  • Keratoderma, Palmoplantar* / etiology
  • Salicylic Acid
  • Water / adverse effects


  • Anti-Inflammatory Agents, Non-Steroidal
  • Water
  • Salicylic Acid