Transient reactive papulotranslucent acrokeratoderma is an unusual condition of the palms that has been characterized by symmetric, hypopigmented, flat-topped papules and plaques with eccrine duct prominence that becomes more pronounced on exposure to water. Histopathologically, hyperkeratosis and dilated eccrine ostia are seen. Two teenagers with papulotranslucent acrokeratoderma are described. We propose the term aquagenic syringeal acrokeratoderma, which accurately describes the appearance after exposure to water and the prominent eccrine ducts seen clinically and histologically in the setting of acrokeratoderma. (J Am Acad Dermatol 2001;45:124-6.)