Unusual Case: Man's Hands Develop 'Scales' After Washing Due to Scarce Ailment

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dac8f2884″>The subject: A male in his 20s residing in China

The indications: A man sought care from the dermatology section of a clinic after enduring a collection of signs for approximately three years. Upon dipping his hands in water, such as when washing up, the skin surface on the back of the man’s hands became denser and overly furrowed, accompanied by the emergence of whitish elevations and growths.

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The man had earlier looked for medical care at his nearby physician, where he obtained a diagnosis of persistent eczema — which prompts the skin to turn arid, firm, and pruritic — and gained a prescription for a potent retinoid cream, which he employed occasionally. On the contrary, this course of action proved ineffective, and his manifestations steadily deteriorated. His wrists and elbows had likewise initiated the development of integumentary lesions over the span of 1.5 years preceding the hospital appointment.

The subject displayed no familial precedents of analogous integumentary disorders and did not undergo exorbitant perspiration or harbor any allergic responses, and had never inflicted harm to his hands. The man ascribed the escalation of his ailment to his amplified frequency of hand hygiene throughout the COVID-19 global health crisis, the medical professionals documented in the report concerning the case.

What transpired subsequently: Amid a physical assessment conducted at the medical center, the man’s hands were drenched in liquid for a duration of 10 minutes, instantaneously inducing the superior surfaces of his hands, digits, and wrists to evolve into a state of redness, flakiness, and corrugation accompanied by whitish pathologies. Notably, the “excessive wrinkling” and protuberances culminated in a linear trajectory along the sides of his hands, sparing his palms from involvement.

The physicians procured biopsies originating from the whitish excrescences on his right hand, which brought to light that the perspiration channels inside the epidermal layer had widened and accommodated a greater number of sudoriferous glands than usual. The outcomes additionally denoted he possessed hyperkeratosis, connoting his system was overproducing the protein keratin, thereby instigating the augmentation of the exterior skin stratum.

The healthcare unit noted that “the subject’s clinical advancement held significant intrigue,” given that the symptoms tied to the integumentary ailment materialized exclusively post his hands being inundated by water and all manifestations dissipated in the vicinity of 30 minutes following the desiccation of his hands.

Biopsies collected from the whitish elevations on the man’s hands (magnified previously) unveiled that the sudoriferous channels across the area of his skin were unusually ample.

The pronouncement: On the grounds of the way his manifestations surfaced within the healthcare setting and the results generated from the biopsy, the doctors identified the subject as possessing a condition denoted as aquagenic syringeal acrokeratoderma (ASA). Still, in practically all diverse instances, it bears upon the palms, not the backs of hands or fingers.

The ephemeral manifestations of this dermal ailment are commonly referred to as the “hand in the bucket sign,” owing to their commencement subsequent to hand submersion in fluid. The manifestations generally recede inside several hours of drying, but a subcategory of individuals afflicted by ASA showcase tenacious cutaneous afflictions that undergo exacerbation upon water contact, according to the Genetic and Rare Diseases Information Center (GARD).

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The origin of ASA is presently indeterminate, though it might correlate to “an obtained sudoriferous gland irregularity” or some instigator that prompts the thickening of skin, as evidenced by scrutiny conveyed in the Journal of the American Academy of Dermatology.

The handling: The patient experienced treatment by means of topical hydrocortisone urea ointment, which exists as a corticosteroid coupled with a dermal hydrator that can be employed straight onto the impacted region. It’s standardly implemented for attending to dermal exasperation, swelling events, and erythema.

The medical staff likewise suggested that the patient limit their hand exposure to wetness beyond strictly mandatory thresholds. The man remained in attendance at check-up consultations at the juncture the medical personnel chronicled his occurrence, and they signaled that his manifestations had notably subsided after merely a solitary month.

OTHER DILEMMAS

—A man’s muscles appeared strangely misshapen. Physicians detected they were discharging calcium into his bloodstream

—A woman developed odd contusions as a result of employing a massage applicator. It surfaced that she had scurvy.

—A rare genetic ailment tinged a woman’s cardiac muscle pitch black

Aspects rendering the case idiosyncratic: ASA comes across as a scant ailment, while its precise degree of commonness defies ascertainment.

Data tips that the ailment sees greater prevalence in adolescent females, the case report’s authors indicated. It likewise occurs in close to 40% to 84% of cystic fibrosis (CF) sufferers and carriers, signifying individuals who hold a singular copy of the CF genetic modification, according to GARD. (The bearing of two copies is requisite to bear CF.) This arrangement suggests the possibility of ASA stemming to a partial extent from transformations within that gene, at the very least within particular scenarios.

According to the clinicians in the report, the subject recounted in this scenario formed the inaugural instance known to bear ASA that bypassed influence over his palms. Elucidation as to what underpinned his case’s presentation diverging from prior accounts remains elusive.

For more intriguing medical cases, check out our Diagnostic Dilemma archives.

Disclaimer

This article is for informational purposes only and is not meant to offer medical advice.

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Sophie BerdugoSocial Links NavigationStaff writer

Sophie assumes the function of a staff writer anchored in the U.K. at Live Science. Her attention spans diverse spheres, possessing reporting history from bonobo communication to primal extraterrestrial water. Her contributions have likewise surfaced in outlets like New Scientist, The Observer, and BBC Wildlife, and she received a nomination for the Association of British Science Writers’ 2025 “Newcomer of the Year” designation in acknowledgement of her freelance commitments at New Scientist. Preceding her journey as a science journalist, she accomplished a doctorate specializing in evolutionary anthropology from the University of Oxford, devoting four years towards the examination of reasons underlying superior tool competence exhibited by specific chimpanzees contrasted to others.

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