Aquagenic Wrinkling of the Palms: Response to Topical Tacrolimus.

Aquagenic wrinkling of the palms (AWoP) is a rare dermatosis of significant psychosocial embarrassment and missed employment opportunities. It is characterized by development of translucent papules and wrinkling of the palms and rarely of soles shortly after immersion in water. Associated burning pain or pruritus of variable intensity is often distressing. The symptoms subside spontaneously 10-60 minutes after drying of hands only to recur following contact with water resulting in mild palmar hyperkeratosis over time. Although, cystic fibrosis remains the most described association, its cause is unknown in majority. The treatment is usually unsatisfactory and remains challenging. Response to antihistamines, iontophoresis, topical aluminum chloride 15-20% solution, and aluminum chloride hexahydrate 20% in anhydrous ethyl alcohol remains inconsistent. Keratolytic creams, petroleum jelly and/or use of gloves are not found useful at all. This paper describes a case of AWoP treated successfully with topical tacrolimus 0.1% ointment. We feel that topical tarolimus provides an effective and safe therapeutic option in AWoP.

The Association Between Chronic Plaque Psoriasis and Nonalcoholic Fatty Liver Disease in Indian Patients: Results of a Pilot Study.

Background: Psoriasis is a chronic dermatosis with potential to cause systemic disease by triggering dysmetabolism, such as metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). We studied the relationship and associations between NAFLD and clinical features, including age, gender, disease duration, and severity of psoriasis in our patients. Methods: This cross-sectional study comprised 61 (m:f, 43:19) patients without pre-existing comorbidities and matched 24 (m:f, 16:8) healthy controls aged between 20 and 68 years. Disease severity was graded as mild, moderate, and severe by psoriasis area and severity index score and body surface area (BSA) involvement. The grades of fatty liver and liver fibrosis were assessed using liver ultrasonography (USG) and transitional vibration-controlled elastography (Fibroscan). Results: Overall, 67.2% of patients were aged >40 years, and the duration of disease was <5years in 60.7% of patients. Mild and moderate to severe psoriasis occurred in 78.7% and 21.3% of patients, respectively. BSA was >10% in 57.5% patients. The proportion of NAFLD was 27.9% and 32.8% by USG and Fibroscan compared with 20.8% in controls. Statistically, there was no significant difference or association between the prevalence of NAFLD among patients and controls, and gender, age (mean ± standard deviation, 47.5 ± 13.8 vs. 45.2 ± 15.7), duration, severity of psoriasis, and arthritis between psoriatic patients with and without NAFLD. Conclusion: This was a pilot study because of the numerosity of sample and highlights trends for possible link between psoriasis and NAFLD, but the results need cautious interpretation and clinical application. Whether NAFLD can be attributed to overall systemic inflammatory process of psoriasis or it occurs as an epiphenomenon of concurrent metabolic syndrome needs elucidation with well-designed studies. Cross-sectional study design, small number of patients, and controls remain major limitations. The study did not compare its findings with liver biopsy.