A Case of Aquagenic Syringeal Acrokeratoderma in a Male Patient Undergoing Treatment With an Angiotensin-Converting Enzyme Inhibitor

Aquagenic syringeal acrokeratoderma (ASA) is a rare dermatological condition characterized by the transient appearance of edematous, white, translucent papules on the palms following water exposure. While the condition is most commonly associated with cystic fibrosis (CF) and predominantly affects young women, this report presents a unique case in a 24-year-old man without a history of cystic fibrosis. The patient reported a 10-month history of painful, pruritic eruptions on the hands following exposure to water. Symptoms resolved within an hour post-exposure but were persistent and increasingly severe over time. The patient's medical history was unremarkable, except for the use of lisinopril for hypertension and propranolol for performance anxiety. Given the absence of CF, the etiology of the disease in this patient remains unclear; however, the use of an angiotensin-converting enzyme (ACE) inhibitor is hypothesized to have contributed to the onset of symptoms through mechanical mechanisms involving sodium retention and osmotic gradient disruption in keratinocytes. This case highlights the diverse clinical presentations and emphasizes the importance of considering ASA in the differential diagnosis of patients without CF or other traditional risk factors. This case underscores the need for further research to elucidate the underlying mechanisms and improve diagnostic accuracy for this rare but potentially debilitating condition.