Palmar plantar erythrodysesthesia differential diagnosis: Difference between revisions
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{{Palmar plantar erythrodysesthesia}} | {{Palmar plantar erythrodysesthesia}} | ||
{{CMG}}, Zain Fatiwala M.D. | {{CMG}}, '''Associate Editor(s)-in-Chief:''' Zain Fatiwala, M.D. | ||
==Overview== | ==Overview== | ||
Palmar plantar erythrodysesthesia should be differentiated from other conditions that may have the same presentation. Some of these conditions are acute graft versus host response, tinea manuum infection, and Hand-foot skin reaction due to tyrosine kinase inhibitor. | Palmar plantar erythrodysesthesia should be differentiated from other conditions that may have the same presentation. Some of these conditions are acute graft versus host response, tinea manuum infection, and Hand-foot skin reaction due to tyrosine kinase inhibitor. | ||
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* Palmar Plantar Erythrosysesthesia must be differentiated from Tinea manuum which can also present in patients being treated with chemotherapy. Tinea Manuum infection responds to antifungal therapy. | * Palmar Plantar Erythrosysesthesia must be differentiated from Tinea manuum which can also present in patients being treated with chemotherapy. Tinea Manuum infection responds to antifungal therapy. | ||
* Palmar Plantar Erythrosysesthesia should be differentiated from Acute Graft Versus Host Response commonly seen in bone marrow transplanted patients who are on chemotherapy such as in leukemia.<ref name="pmid9329890">{{cite journal| author=Demirçay Z, Gürbüz O, Alpdoğan TB, Yücelten D, Alpdoğan O, Kurtkaya O et al.| title=Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases. | journal=Int J Dermatol | year= 1997 | volume= 36 | issue= 8 | pages= 593-8 | pmid=9329890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9329890 }}</ref> In graft-versus-host disease the condition progresses to involve other regions of the body. Palmar Plantar Erythrosysesthesia, on the the other hand is limited to hands and feet. Differentiating the two disorders is possible with either clinical features or serial biopsies every 3 - 5 days.<ref name="pmid3527075">{{cite journal| author=Crider MK, Jansen J, Norins AL, McHale MS| title=Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation. | journal=Arch Dermatol | year= 1986 | volume= 122 | issue= 9 | pages= 1023-7 | pmid=3527075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3527075 }}</ref> | * Palmar Plantar Erythrosysesthesia should be differentiated from Acute Graft Versus Host Response commonly seen in bone marrow transplanted patients who are on chemotherapy such as in leukemia.<ref name="pmid9329890">{{cite journal| author=Demirçay Z, Gürbüz O, Alpdoğan TB, Yücelten D, Alpdoğan O, Kurtkaya O et al.| title=Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases. | journal=Int J Dermatol | year= 1997 | volume= 36 | issue= 8 | pages= 593-8 | pmid=9329890 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9329890 }}</ref> These conditions are difficult to differentiate as in the first three weeks histological and clinical presentation of PPE may possibly resemble acute GVHD. In graft-versus-host disease the condition progresses to involve other regions of the body. Palmar Plantar Erythrosysesthesia, on the the other hand is limited to hands and feet. Differentiating the two disorders is possible with either clinical features or serial biopsies every 3 - 5 days.<ref name="pmid3527075">{{cite journal| author=Crider MK, Jansen J, Norins AL, McHale MS| title=Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation. | journal=Arch Dermatol | year= 1986 | volume= 122 | issue= 9 | pages= 1023-7 | pmid=3527075 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3527075 }}</ref> It is vital to differentiate these conditions as GVHD can be fatal if not treated aggressively. | ||
* Palmar Plantar Erythrosysesthesia can have similar presentation to Hand-foot skin reaction due to tyrosine kinase inhibitor. They can be differentiated with clinical presentation. PPE presents with diffuse erythema due to cytotoxic reaction while Hand-foot skin reaction has focal hyperkeratotic lesions.<ref name="pmid24795111">{{cite journal| author=Miller KK, Gorcey L, McLellan BN| title=Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management. | journal=J Am Acad Dermatol | year= 2014 | volume= 71 | issue= 4 | pages= 787-94 | pmid=24795111 | doi=10.1016/j.jaad.2014.03.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24795111 }}</ref> | * Palmar Plantar Erythrosysesthesia can have similar presentation to Hand-foot skin reaction due to tyrosine kinase inhibitor. They can be differentiated with clinical presentation. PPE presents with diffuse erythema due to cytotoxic reaction while Hand-foot skin reaction has focal hyperkeratotic lesions.<ref name="pmid24795111">{{cite journal| author=Miller KK, Gorcey L, McLellan BN| title=Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management. | journal=J Am Acad Dermatol | year= 2014 | volume= 71 | issue= 4 | pages= 787-94 | pmid=24795111 | doi=10.1016/j.jaad.2014.03.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24795111 }}</ref> | ||
Revision as of 22:29, 7 October 2018
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Differentiating Palmar plantar erythrodysesthesia from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Zain Fatiwala, M.D.
Overview
Palmar plantar erythrodysesthesia should be differentiated from other conditions that may have the same presentation. Some of these conditions are acute graft versus host response, tinea manuum infection, and Hand-foot skin reaction due to tyrosine kinase inhibitor.
Differential diagnosis
The problem arises in patients after bone marrow transplants, as the clinical and histologic features of PPE can be similar to cutaneous manifestations of acute (first 3 weeks) graft-versus-host disease. It is important to differentiate PPE, which is benign, from the more dangerous graft-versus-host disease. As time progresses, patients with graft-versus-host disease progress to have other body parts affected, while PPE is limited to hands and feet. Serial biopsies every 3 to 5 days can also be helpful in differentiating the two disorders (Crider et al, 1986).
- Palmar Plantar Erythrosysesthesia must be differentiated from Tinea manuum which can also present in patients being treated with chemotherapy. Tinea Manuum infection responds to antifungal therapy.
- Palmar Plantar Erythrosysesthesia should be differentiated from Acute Graft Versus Host Response commonly seen in bone marrow transplanted patients who are on chemotherapy such as in leukemia.[1] These conditions are difficult to differentiate as in the first three weeks histological and clinical presentation of PPE may possibly resemble acute GVHD. In graft-versus-host disease the condition progresses to involve other regions of the body. Palmar Plantar Erythrosysesthesia, on the the other hand is limited to hands and feet. Differentiating the two disorders is possible with either clinical features or serial biopsies every 3 - 5 days.[2] It is vital to differentiate these conditions as GVHD can be fatal if not treated aggressively.
- Palmar Plantar Erythrosysesthesia can have similar presentation to Hand-foot skin reaction due to tyrosine kinase inhibitor. They can be differentiated with clinical presentation. PPE presents with diffuse erythema due to cytotoxic reaction while Hand-foot skin reaction has focal hyperkeratotic lesions.[3]
References
- ↑ Demirçay Z, Gürbüz O, Alpdoğan TB, Yücelten D, Alpdoğan O, Kurtkaya O; et al. (1997). "Chemotherapy-induced acral erythema in leukemic patients: a report of 15 cases". Int J Dermatol. 36 (8): 593–8. PMID 9329890.
- ↑ Crider MK, Jansen J, Norins AL, McHale MS (1986). "Chemotherapy-induced acral erythema in patients receiving bone marrow transplantation". Arch Dermatol. 122 (9): 1023–7. PMID 3527075.
- ↑ Miller KK, Gorcey L, McLellan BN (2014). "Chemotherapy-induced hand-foot syndrome and nail changes: a review of clinical presentation, etiology, pathogenesis, and management". J Am Acad Dermatol. 71 (4): 787–94. doi:10.1016/j.jaad.2014.03.019. PMID 24795111.