In addition, both disorders may be seen simultaneously in a patient.
In addition, both disorders may be seen simultaneously in a patient.
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===
On the basis [symptom 1], [symptom 2], and [symptom 3], [disease name] must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Clinical manifestations'''
! colspan="7" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;|Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical examination
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Lab Findings
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;|Imaging
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;|Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 1
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Symptom 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;|Physical exam 1
PPE must be differentiated from Graft-Versus-Host Disease (GVHD) and Stenvens-Johnson Syndrome.
Differentiating palmar plantar erythrodysesthesia from other Diseases
The two most important differential diagnoses of PPE:
Acute Graft-Versus-Host Disease (AGVHD) in patients who have received a bone marrow transplant
Stevens-Johnson syndrome (SJS).
The distinction of these clinical entities are important since the treatments are distinct and a biopsy may not be able to distinguish them in a clinically relevant time frame.
In differentiating between PPE and AGVHD, the following factors suggest the presence of AGVHD:
Different pattern of involvement of the palms and soles in AGVHD: a diffuse macular erythema which may form papules in contrast to the areas of well-defined intense erythema and edema in PPE [1]
Extracutaneous manifestations of AGVHD, including [1]:
gastrointestinal symptoms such as diarrhea and abdominal pain
elevated liver enzymes
A rapid drop in the T helper cell/suppressor cell ratio
The presence of degenerate keratinocytes at all levels of the epidermis and associated with adjacent lymphocytes (satellite cell necrosis) in AGVHD [2] in contrast to the presence of squamous syringometaplasia which suggests PPE [1]
However, histologic features of both diseases are identical in early stages and serial biopsies may be needed to distinguish these two entities. [3]
In addition, both disorders may be seen simultaneously in a patient.
