Palmar plantar erythrodysesthesia differential diagnosis: Difference between revisions

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==Overview==
==Overview==
PPE must be differentiated from [[Graft-versus-host disease|Graft-Versus-Host Disease]] ([[GVHD]]).
Palmar plantar erythrodysesthesia (PPE) must be differentiated from other [[Skin disorder|skin disorders]] that involve [[Hand|palms]] and/or [[Sole (foot)|soles]], such as [[Graft-versus-host disease]], [[contact dermatitis]], [[Plaque psoriasis|palmoplantar plaque psoriasis]], [[dyshidrotic eczema]], and [[Pustulosis|palmoplantar pustulosis]].  
 
==Differentiating palmar plantar erythrodysesthesia from other Diseases==


==Differentiating Palmar Plantar Erythrodysesthesia from other Diseases==
Palmar plantar erythrodysesthesia (PPE) must be differentiated from other [[Skin disorder|skin disorders]] that involve [[Hand|palms]] and/or [[Sole (foot)|soles]], such as [[Graft-versus-host disease]], [[contact dermatitis]], [[Plaque psoriasis|palmoplantar plaque psoriasis]], [[dyshidrotic eczema]], and [[Pustulosis|palmoplantar pustulosis]].
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Additional diagnostic clues
|-
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''Palmar plantar erythrodysesthesia'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* Areas of well-defined intense [[erythema]] and [[edema]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* A variable degree of [[Epidermis (skin)|epidermal]] ([[Keratinocyte|keratinocytes]]) [[necrosis]] <ref name="pmid8468414">{{cite journal| author=Fitzpatrick JE| title=The cutaneous histopathology of chemotherapeutic reactions. | journal=J Cutan Pathol | year= 1993 | volume= 20 | issue= 1 | pages= 1-14 | pmid=8468414 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8468414  }} </ref>
* Vacuolar degeneration of the [[Stratum germinativum|basal cell layer]] of [[Epidermis (skin)|epidermis]]
* Spongiosis
*[[Hyperkeratosis]]
* Lymphohistiocytic infiltrates
*[[Superficial (human anatomy)|Superficial]] perivascular infiltration of [[dermis]] by [[Lymphocyte|lymphocytes]] and [[eosinophils]]
*[[Papilla|Papillary]] [[Dermis|dermal]] [[edema]]
* Neutrophilic eccrine hidradenitis
* Eccrine squamous syringometaplasia, in severe PPE ([[World Health Organization|WHO]] grades 3 and 4)<ref name="pmid9236526">{{cite journal| author=Valks R, Fraga J, Porras-Luque J, Figuera A, Garcia-Diéz A, Fernändez-Herrera J| title=Chemotherapy-induced eccrine squamous syringometaplasia. A distinctive eruption in patients receiving hematopoietic progenitor cells. | journal=Arch Dermatol | year= 1997 | volume= 133 | issue= 7 | pages= 873-8 | pmid=9236526 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9236526  }} </ref>
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* History of [[chemotherapeutic agent]] use
|-
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Graft-versus-host disease|Graft-versus-host disease (GVHD)]]'''
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* A diffuse [[Macule|macular]] [[erythema]] which may form [[Papule|papules]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
*[[Histology|Histologic]] features of [[Graft-versus-host disease]] and palmar plantar erythrodysesthesia are identical in early stages and serial [[biopsies]] may be needed to distinguish between these two entities.
* Features suggestive of [[Graft-versus-host disease]]:<ref name="pmid23008">{{cite journal| author=Sale GE, Lerner KG, Barker EA, Shulman HM, Thomas ED| title=The skin biopsy in the diagnosis of acute graft-versus-host disease in man. | journal=Am J Pathol | year= 1977 | volume= 89 | issue= 3 | pages= 621-36 | pmid=23008 | doi= | pmc=2032260 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23008  }} </ref>


:* Degenerate [[Keratinocyte|keratinocytes]] at all levels of the [[Epidermis (skin)|epidermis]]
:* Adjacent [[Lymphocyte|lymphocytes]] (satellite cell [[necrosis]])
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* Extracutaneous manifestations of [[Acute (medicine)|Acute]] [[Graft-versus-host disease|GVHD]], including:<ref name="pmid9236526">{{cite journal| author=Valks R, Fraga J, Porras-Luque J, Figuera A, Garcia-Diéz A, Fernändez-Herrera J| title=Chemotherapy-induced eccrine squamous syringometaplasia. A distinctive eruption in patients receiving hematopoietic progenitor cells. | journal=Arch Dermatol | year= 1997 | volume= 133 | issue= 7 | pages= 873-8 | pmid=9236526 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9236526  }} </ref>


{| class="wikitable"
:*[[Gastrointestinal]] [[symptoms]], such as [[diarrhea]] and [[abdominal pain]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
:* Elevated [[liver enzymes]]
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical Characteristics
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other clues to the diagnosis
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cutaneous T cell lymphoma]]/[[Mycosis fungoides]]<ref name="urlMycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/lymphoma/patient/mycosis-fungoides-treatment-pdq |title=Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Allergic contact dermatitis]]'''<ref name="">{{cite book | last = Goldsmith | first = Lowell | title = Fitzpatrick's dermatology in general medicine | publisher = McGraw-Hill Medical | location = New York | year = 2012 | isbn = 978-0-07-166904-7 }}</ref>
|
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
* '''Premycotic phase:''' A scaly, red [[rash]] in areas of the [[body]] that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
* Well-demarcated, [[Eczema|eczematous]] eruptions localized to the area of [[skin]] that in contact with the culprit [[allergen]]
* '''Patch phase:''' Thin, [[erythematous]], [[eczema]]-like rash.
* '''[[Plaque]] phase:''' Small raised [[Bumps on skin|bumps]] ([[Papule|papules]]) or hardened [[lesions]] on the skin, which may be [[erythematous]].
* '''[[Tumor]] phase:''' Tumors form on the [[skin]]. [[Infection]] secondary to [[Ulcer|ulcers]].
|
* [[Epidermis (skin)|Epidermal]] [[atrophy]] or poikiloderma


* Generalized [[itching]] ([[pruritus]])
:*[[Acute (medicine)|Acute]] eruption: [[Vesicle (biology)|Vesicular]]
* [[Pain]] in the affected area of the skin
:*[[Chronic (medical)|Chronic]] eruption: [[Lichenification|Lichenified]] and scaly [[Plaque|plaques]]
* [[Insomnia]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]  
*[[Eosinophilic]] spongiosis
* Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease
*[[Exocytosis]] of [[eosinophils]] and [[Lymphocyte|lymphocytes]]
* [[Weight loss]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* [[Lymphadenopathy]]
* History of [[allergen]] exposure
* [[Malaise]] and [[fatigue]]
*[[Pruritis|Pruritic]] [[lesions]]
* [[Anemia]]
* Patch [[Experiment|testing]] may help to identify [[Allergen|allergens]]
* May progress to [[Sezary syndrome]] (skin involvement plus hematogenous dissemination)
|
* [[Sezary syndrome]]
|
[[Image:Mycosis_fungoides.JPG|200px|courtesy of wikipedia.org]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Psoriasis|Palmoplantar plaque psoriasis]]'''
|
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* Pink or salmon in color, which may be scaly; referred to as "herald patch"
* Sharply defined [[Erythema|erythematous]], scaly [[Plaque|plaques]] on the [[Hand|palms]] and/or [[Sole (foot)|soles]]
* Oval shape
*[[Fissure|Fissures]]
* Long axis oriented along the cleavage lines
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* Distributed on the [[trunk]] and [[proximal extremities]]
* Acanthosis
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on  posterior trunk
*[[Hyperkeratosis]]
* Secondary to [[viral infection]]<nowiki/>s
* Parakeratosis
* Resolves spontaneously after 6-8 weeks
* Neutrophilic infiltration in the [[Epidermis (skin)|epidermis]] and [[stratum corneum]] (Kogoj pustules and Munro's [[Abscesses|microabscesses]])
|
* Abundant mononuclear [[cells]] (mainly [[Myelocyte|myeloid cells]] and [[T cell|T cells]]) in the [[dermis]]
* Preceded by a prodrome of:
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
** [[Sore throat]]
*[[Itch|Pruritus]] is common
** [[Gastrointestinal tract|Gastrointestinal]] disturbance
* Positive [[Koebner phenomenon]]
** [[Fever]]
** [[Arthralgia]]
|
* Infection by any of the following:<ref name="pmid19997691">{{cite journal |vauthors=Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A |title=Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea |journal=Acta Derm. Venereol. |volume=89 |issue=6 |pages=604–6 |year=2009 |pmid=19997691 |doi=10.2340/00015555-0703 |url=}}</ref>
** [[Human herpesvirus 6|HHV-6]]
** [[HHV-7]]
** [[HHV-8]]
|
[[Image:Pityriasisrosea.png|200px|courtesy of https://commons.wikimedia.org]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis lichenoides chronica]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Dyshidrotic eczema]]'''
|
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
* Deep-seated clear [[vesicles]]; later, [[Scaling skin|scaling]], [[Fissure|fissures]] and [[lichenification]] occur
* Brownish red or orange-brown in color
* Deep-seated [[Vesicle|vesicles]] or [[Blister|blisters]] on the tips and lateral sides of the [[Finger|fingers]], [[Hand|palms]], and [[Sole (foot)|soles]] with subsequent [[Scaling skin|scaling]], [[Fissure|fissures]] and [[lichenification]]
* [[Lesions]] are capped by a single detachable, opaque, mica-like scale
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
*[[Acute (medicine)|Acute:]]
|
 
* High [[fever]]  
:* Intraepidermal spongiotic [[Vesicle|vesicles]] or bullae that do not involve the intraepidermal portion of the [[Eccrine sweat glands|eccrine sweat duct]] (acrosyringium)
* [[Malaise]]
:* A sparse, superficial perivascular infiltrate of [[Lymphocyte|lymphocytes]]
* [[Myalgias]]
 
* [[Paraesthesia]]
*[[Chronic (medical)|Chronic:]]
* [[Pruritis|Pruritus]]
|
* Infection by any of the following:<ref name="pmid9109005">{{cite journal |vauthors=Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF |title=Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR) |journal=Int. J. Dermatol. |volume=36 |issue=2 |pages=104–9 |year=1997 |pmid=9109005 |doi= |url=}}</ref>
** [[Epstein Barr virus|Epstein-Barr virus]] (EBV)
** ''[[Toxoplasma gondii]]''
** [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
|
[[Image:PLEVA2.jpg|200px|courtesy of http://www.regionalderm.com]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nummular dermatitis]]<ref name="pmid23517392">{{cite journal |vauthors=Jiamton S, Tangjaturonrusamee C, Kulthanan K |title=Clinical features and aggravating factors in nummular eczema in Thais |journal=Asian Pac. J. Allergy Immunol. |volume=31 |issue=1 |pages=36–42 |year=2013 |pmid=23517392 |doi= |url=}}</ref>
|
* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]  
* Commonly affecting the [[extremities]] (lower>upper) and [[trunk]]
* May ooze [[fluid]] and become dry and crusty
|
* Often appears after a skin injury, such as a [[burn]], [[abrasion]] (from friction), or [[insect bite]]


* [[Lesions]] commonly relapse after occasional remission or may persist for long periods
:* Predominance of parakeratosis and acanthosis with minimal or no spongiosis and a [[dermal]] [[Lymphocyte|lymphocytic]] infiltrate
* [[Pruritis|Pruritus]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
|
* Intensely [[Pruritis|pruritic]]
* Associated with:
* History of recurrence
** Dry skin
** Emotional stress
** [[Allergens]] (rubber chemicals, [[formaldehyde]], [[neomycin]], chrome, [[Mercury (element)|mercury]], and [[nickel]])
** [[Staphylococcus]] infection
** Seasonal variation
** [[Alcohol]]
** [[Drugs]]
** [[Atopy]]
|
[[Image:Nummular dermatitis dry.jpg|200px|courtesy of your-doctor.net dermatology atlas]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Secondary syphilis]]<ref name="urlSTD Facts - Syphilis">{{cite web |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm |title=STD Facts - Syphilis |format= |work= |accessdate=}}</ref>
|
* Round, coppery, red colored [[lesions]] on palms and soles
* [[Papule|Papules]] with collarette of scales
|
* [[Fever]]
* [[Lymphadenopathy|Generalized lymphadenopathy]]
* [[Sore throat]]
* [[Hair loss|Patchy hair loss]]
* [[Headaches|Headache]]
* [[Weight loss]]
* [[Myalgia]]
* [[Fatigue]]
|
* Associated with:
** [[Condyloma latum|Condylomata lata]]
** Corona verinata
** Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] test
|
[[Image:Secondary_Syphilis.jpg|200px|courtesy of wikipedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
|
* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]
* Well-defined margins
|
* [[Pruritis|Pruritus]]
* [[Pain]]
* Bleeding [[lesions]]
|
* Associated with:<ref name="pmid25201325">{{cite journal |vauthors=Murao K, Yoshioka R, Kubo Y |title=Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease |journal=J. Dermatol. |volume=41 |issue=10 |pages=878–84 |year=2014 |pmid=25201325 |doi=10.1111/1346-8138.12613 |url=}}</ref>
** [[Erythroplasia of Queyrat]] ([[Bowen's disease]] of the [[penis]])
** [[Squamous cell carcinoma]]
** Solar radiation and [[ultraviolet]] (UV) exposure
** [[Radiation therapy|Radiotherapy]]
** [[Immunosuppression]]
** [[Arsenic]] exposure
** [[Human papillomavirus|Human papilloma virus]] (HPV) type 16
** [[Polyomavirus|Merkel cell polyomavirus]]
** [[Sjögren's syndrome|Sjögren’s syndrome]]
|
[[Image:Bowen.jpg|200px|courtesy of wikipedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Exanthematous pustulosis]]<ref name="pmid26354880">{{cite journal |vauthors=Szatkowski J, Schwartz RA |title=Acute generalized exanthematous pustulosis (AGEP): A review and update |journal=J. Am. Acad. Dermatol. |volume=73 |issue=5 |pages=843–8 |year=2015 |pmid=26354880 |doi=10.1016/j.jaad.2015.07.017 |url=}}</ref>
|
* Numerous small, primarily non-follicular, sterile [[pustules]], arising within large areas of [[Edema|edematous]] [[erythema]]
|
* [[Fever]]
* [[Leukocytosis]]
* Intracorneal, subcorneal, and/or intraepidermal [[pustules]] with [[papillary]] [[dermal]] [[edema]] containing [[neutrophils]] and [[eosinophils]]
|
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
** [[Antibiotics]] ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** [[Carbamazepine]]
** [[Calcium channel blocker|Calcium channel blockers]] ([[Diltiazem]])
** [[Hydroxychloroquine]]
|
[[Image:Acute_generalized_exanthematous_pustulosis.jpg|200px|commons.wikimedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lichen planus|Hypertrophic lichen planus]]<ref name="pmid27222766">{{cite journal |vauthors=Ankad BS, Beergouder SL |title=Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective |journal=Dermatol Pract Concept |volume=6 |issue=2 |pages=9–15 |year=2016 |pmid=27222766 |pmc=4866621 |doi=10.5826/dpc.0602a03 |url=}}</ref>
|
* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
* [[Lesions]] may transform into [[Hyperkeratosis|hyperkeratotic]] thickened, elevated, purplish or reddish [[Plaque|plaques]] and [[nodules]]
|
* Chronic [[pruritis|pruritus]]
* Scaling
* May be [[asymptomatic]]
|
* Associated with [[Hepatitis C virus]] infection<ref name="pmid19770446">{{cite journal |vauthors=Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W |title=Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis |journal=Arch Dermatol |volume=145 |issue=9 |pages=1040–7 |year=2009 |pmid=19770446 |doi=10.1001/archdermatol.2009.200 |url=}}</ref>
|
[[Image:Lichen_planus2.JPG|200px|courtesy of wikipedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sneddon–Wilkinson disease<ref name="pmid9564592">{{cite journal |vauthors=Lutz ME, Daoud MS, McEvoy MT, Gibson LE |title=Subcorneal pustular dermatosis: a clinical study of ten patients |journal=Cutis |volume=61 |issue=4 |pages=203–8 |year=1998 |pmid=9564592 |doi= |url=}}</ref>
|
* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
* Annular configuration
|
* [[Pruritis|Pruritus]]
* May be asymptomatic
|
* Associated with:
** [[Monoclonal gammopathy]], usually an [[IgA]] paraproteinemia<ref name="pmid3056995">{{cite journal |vauthors=Kasha EE, Epinette WW |title=Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature |journal=J. Am. Acad. Dermatol. |volume=19 |issue=5 Pt 1 |pages=854–8 |year=1988 |pmid=3056995 |doi= |url=}}</ref>
** [[Crohn's disease]]<ref name="pmid1357895">{{cite journal |vauthors=Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H |title=Subcorneal pustular dermatosis in a patient with Crohn's disease |journal=Acta Derm. Venereol. |volume=72 |issue=4 |pages=301–2 |year=1992 |pmid=1357895 |doi= |url=}}</ref>
** [[Osteomyelitis]]
** [[Adalimumab]]<ref name="pmid23489057">{{cite journal |vauthors=Sauder MB, Glassman SJ |title=Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis |journal=Int. J. Dermatol. |volume=52 |issue=5 |pages=624–8 |year=2013 |pmid=23489057 |doi=10.1111/j.1365-4632.2012.05707.x |url=}}</ref>
|
[[Image:Sneddon wilkinson disease 03.jpeg|200px|courtesy http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=427]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
|
* [[Erythematous]] [[plaques]] with fine scaly surface
* May present with elongated, finger-like patches
* Symmetrical distribution on the flanks
* Known as digitate dermatosis
|
* [[Lesions]] may be [[asymptomatic]]
* May be mildly [[Itch|pruritic]]  
* May fade or disappear after sun exposure during the summer season, but typically recur during the winter
|
* May progress to [[mycosis fungoides]]<ref name="pmid16191852">{{cite journal |vauthors=Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A |title=A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides |journal=Acta Derm. Venereol. |volume=85 |issue=4 |pages=318–23 |year=2005 |pmid=16191852 |doi=10.1080/00015550510030087 |url=}}</ref>
|
[[Image:Small_plaque_parapsoriasis.jpg|200px|courtesy http://www.regionalderm.com]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intertrigo]]<ref name="pmid16156342">{{cite journal |vauthors=Janniger CK, Schwartz RA, Szepietowski JC, Reich A |title=Intertrigo and common secondary skin infections |journal=Am Fam Physician |volume=72 |issue=5 |pages=833–8 |year=2005 |pmid=16156342 |doi= |url=}}</ref>
|
* Red and fleshy looking [[lesion]] in [[skin]] folds
* [[Itching]]
* Oozing
* May be sore
|
* [[Pruritis|Pruritus]]
* Musty odor
|
* Associated with:
** [[Infections]] (Fungal, bacterial, viral)
** [[Allergies]]
** [[Diabetes Mellitus|Diabetes]]
** [[Obesity]]
|
[[Image:Axillary_intertrigo.png|200px|courtesy of cdc.gov]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
|
* Scaling and crusting of [[scalp]]
|
* Pathological fractures<ref name="pmid1636041">{{cite journal |vauthors=Stull MA, Kransdorf MJ, Devaney KO |title=Langerhans cell histiocytosis of bone |journal=Radiographics |volume=12 |issue=4 |pages=801–23 |year=1992 |pmid=1636041 |doi=10.1148/radiographics.12.4.1636041 |url=}}</ref>
* Visceromegaly ([[hepatomegaly]], [[spleenomegaly]])
* [[Chronic cough, severe cold|Chronic cough]]
* [[Dyspnea]]<ref name="pmid17527085">{{cite journal |vauthors=Sholl LM, Hornick JL, Pinkus JL, Pinkus GS, Padera RF |title=Immunohistochemical analysis of langerin in langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases |journal=Am. J. Surg. Pathol. |volume=31 |issue=6 |pages=947–52 |year=2007 |pmid=17527085 |doi=10.1097/01.pas.0000249443.82971.bb |url=}}</ref>
* [[Lymphadenopathy]]
|
* Associated with:
** [[Diabetes insipidus]]<ref name="pmid16047354">{{cite journal |vauthors=Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H |title=Risk factors for diabetes insipidus in langerhans cell histiocytosis |journal=Pediatr Blood Cancer |volume=46 |issue=2 |pages=228–33 |year=2006 |pmid=16047354 |doi=10.1002/pbc.20425 |url=}}</ref>
** [[Pancytopenia]]
|
[[Image:Langerhan_cell_histiocytosis.jpg|200px|courtesy http://www.regionalderm.com]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tinea manuum]]/pedum/capitis<ref name="pmid15050029">{{cite journal |vauthors=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal=Clin Mol Allergy |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |pmc=419368 |doi=10.1186/1476-7961-2-5 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" | '''[[Pustulosis palmaris et plantaris|Palmoplantar pustulosis]]'''
|
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
* Scaling, flaking, and sometimes blistering of the affected areas
* Multiple [[pustules]] on the [[Hand|palms]] and/or [[Sole (foot)|soles]], with surrounding [[erythema]] and [[hyperkeratosis]]
* Hair loss with a black dot on scalp in case of [[tinea capitis]]
*[[Fissure|Fissures]]
|
*[[Nail changes]]
* [[Pruritis|Pruritus]]
* Brown [[macules]] at the site of resolving [[pustules]]
* [[KOH]] preparation of the [[lesions]] confirms [[fungal infection]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |  
|
* Parakeratosis
* Associated with:
* Loss of [[granular layer]]
** [[Diabetes mellitus|Diabetes]]
* Psoriasiform epidermal hyperplasia
** [[Immunosupression]]
* Spongiosis
** Intimate contact with infected person
*[[Pustules]] filled with [[Neutrophil|neutrophils]] and [[eosinophils]] in the upper [[Epidermis (skin)|epidermis]]
** May lead to [[asthma]] exacerbation
*[[Mast cell]] and [[eosinophil]] infiltration in the upper [[dermis]]
|
* Mixed perivascular and diffuse infiltrate in the [[dermis]] ([[Lymphocyte|lymphocytes]], [[neutrophils]], [[eosinophils]], and [[Mast cell|mast cells]])
[[Image:Tinea_pedis.jpg|200px|courtesy regionalderm.com]]
| style="background: #DCDCDC; padding: 5px; text-align: left;" valign="top" |
* Non-[[pustular psoriasis]]-like eruptions may be seen in other areas
*[[Nail changes]] may be seen
*[[Arthralgia]] or unspecified [[arthritis]] may be seen in some [[Patient|patients]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
|
* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
|
* [[Pruritus]]
|
* Associated with:<ref name="pmid16848386">{{cite journal |vauthors=Schwartz RA, Janusz CA, Janniger CK |title=Seborrheic dermatitis: an overview |journal=Am Fam Physician |volume=74 |issue=1 |pages=125–30 |year=2006 |pmid=16848386 |doi= |url=}}</ref>
** [[AIDS]]
** [[Stress]]<ref name="pmid18033062">{{cite journal |vauthors=Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM |title=[Stress and seborrheic dermatitis] |language=French |journal=Ann Dermatol Venereol |volume=134 |issue=11 |pages=833–7 |year=2007 |pmid=18033062 |doi= |url=}}</ref>
** [[Fungal infection]]
** [[Fatigue]]
** [[Sleep deprivation]]
** Change of season
** [[Parkinson's disease|Parkinson's]] disease
** [[Biotin]] deficiency
|
[[Image:Seborrhoeic_dermatitisnew.jpg|200px|courtesy of wikipedia.com]]
|}
|}


Latest revision as of 19:32, 5 August 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Chitsazan, M.D. [2]

Overview

Palmar plantar erythrodysesthesia (PPE) must be differentiated from other skin disorders that involve palms and/or soles, such as Graft-versus-host disease, contact dermatitis, palmoplantar plaque psoriasis, dyshidrotic eczema, and palmoplantar pustulosis.

Differentiating Palmar Plantar Erythrodysesthesia from other Diseases

Palmar plantar erythrodysesthesia (PPE) must be differentiated from other skin disorders that involve palms and/or soles, such as Graft-versus-host disease, contact dermatitis, palmoplantar plaque psoriasis, dyshidrotic eczema, and palmoplantar pustulosis.

Disease Clinical manifestation Histopathology Additional diagnostic clues
Palmar plantar erythrodysesthesia
Graft-versus-host disease (GVHD)
Allergic contact dermatitis[4]
Palmoplantar plaque psoriasis
Dyshidrotic eczema
  • Intraepidermal spongiotic vesicles or bullae that do not involve the intraepidermal portion of the eccrine sweat duct (acrosyringium)
  • A sparse, superficial perivascular infiltrate of lymphocytes
  • Predominance of parakeratosis and acanthosis with minimal or no spongiosis and a dermal lymphocytic infiltrate
  • Intensely pruritic
  • History of recurrence
Palmoplantar pustulosis

References

  1. ↑ Fitzpatrick JE (1993). "The cutaneous histopathology of chemotherapeutic reactions". J Cutan Pathol. 20 (1): 1–14. PMID 8468414.
  2. ↑ 2.0 2.1 Valks R, Fraga J, Porras-Luque J, Figuera A, Garcia-Diéz A, Fernändez-Herrera J (1997). "Chemotherapy-induced eccrine squamous syringometaplasia. A distinctive eruption in patients receiving hematopoietic progenitor cells". Arch Dermatol. 133 (7): 873–8. PMID 9236526.
  3. ↑ Sale GE, Lerner KG, Barker EA, Shulman HM, Thomas ED (1977). "The skin biopsy in the diagnosis of acute graft-versus-host disease in man". Am J Pathol. 89 (3): 621–36. PMC 2032260. PMID 23008.
  4. ↑ Goldsmith, Lowell (2012). Fitzpatrick's dermatology in general medicine. New York: McGraw-Hill Medical. ISBN 978-0-07-166904-7.
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