Adişen Esra, Karaca Fulya, Gürer Mehmet Ali
Gazi University, Faculty of Medicine, Department of Dermatology, Beşevler, Ankara, Turkey.
Am J Clin Dermatol. 2008;9(6):404-9. doi: 10.2165/0128071-200809060-00009.
A 50-year-old woman who presented with intermittent symmetric edema and wrinkling of the palms after soaking in water was found to have transient reactive papulotranslucent acrokeratoderma (TRPA). This is the oldest patient ever reported to have this condition. The patient was advised to avoid water exposure as much as possible and to wear gloves. Topical treatment with 5% salicylic acid in Vaseline also provided some relief. TRPA presents with translucent, white, confluent papules that become evident on the palms after 3-5 minutes' exposure to water (the so-called 'hand-in-the-bucket' sign) and resolve within a short time after drying. It is a rare disorder with fewer than 40 cases having been reported in the world literature. The disease is seen mostly in female patients, with ages ranging from 6 to 44 years prior to our case in a 50-year-old woman. The most common histologic findings are hyperkeratosis and dilated eccrine ostia. The etiopathogenesis of the disease remains unknown but a transitory structural or functional alteration of components of the stratum corneum or aberration of the sweat duct have been considered. TRPA has been reported in patients with cystic fibrosis and more recently, in patients taking selective cyclo-oxygenase-2 inhibitors. Therefore, the pathogenesis of the condition appears to be related to increased water absorption as a result of an increased epidermal sodium level. Treatment with barrier creams such as hydrophilic petrolatum, glycerin emollients, 5-20% salicylic acid in Vaseline, 10% urea cream, and 12% ammonium lactate cream have been reported. Cases with associated hyperhidrosis respond well to aluminum chloride-containing products.
一名50岁女性，在浸水后出现间歇性对称性手掌水肿和起皱，被诊断为短暂反应性丘疹性半透明肢端角化病（TRPA）。这是有该病症报道的年龄最大的患者。建议该患者尽可能避免接触水，并佩戴手套。用凡士林调配的5%水杨酸进行局部治疗也能提供一定缓解。TRPA表现为半透明、白色、融合性丘疹，在接触水3 - 5分钟后手掌上变得明显（即所谓的“桶中手”征），干燥后短时间内消退。这是一种罕见疾病，世界文献报道的病例少于40例。该病多见于女性患者，在我们报道的这名50岁女性病例之前，年龄范围为6至44岁。最常见的组织学表现是角化过度和汗腺导管扩张。该病的病因尚不清楚，但角质层成分的短暂结构或功能改变或汗腺导管异常已被考虑。TRPA已在囊性纤维化患者中报道，最近，也在服用选择性环氧化酶 - 2抑制剂的患者中出现。因此，该病的发病机制似乎与表皮钠水平升高导致的水吸收增加有关。据报道，使用屏障乳膏如亲水性凡士林、甘油润肤剂、凡士林调配的5 - 20%水杨酸、10%尿素乳膏和12%乳酸铵乳膏进行治疗。伴有多汗症的病例对含氯化铝产品反应良好。
