Palmar plantar erythrodysesthesia differential diagnosis: Difference between revisions
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==Overview== | ==Overview== | ||
PPE must be differentiated from Graft-Versus-Host Disease (GVHD). | PPE must be differentiated from [[Graft-versus-host disease|Graft-Versus-Host Disease]] ([[GVHD]]). | ||
==Differentiating palmar plantar erythrodysesthesia from other Diseases== | ==Differentiating palmar plantar erythrodysesthesia from other Diseases== | ||
The two most important differential diagnoses of PPE is Acute Graft-Versus-Host Disease (AGVHD) in patients who have received a bone marrow transplant | The two most important [[Differential diagnosis|differential diagnoses]] of PPE is Acute [[Graft-versus-host disease|Graft-Versus-Host Disease]] (AGVHD) in patients who have received a [[Bone marrow transplantation|bone marrow transplant]] | ||
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. | 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 [[Clinical|clinically]] relevant time-frame. | ||
In differentiating between PPE and AGVHD, the following factors suggest the presence of AGVHD: | 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 <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> | * Different pattern of involvement of the [[Palms of the hands|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 <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> | ||
* Extracutaneous manifestations of AGVHD, 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>: | * Extracutaneous manifestations of AGVHD, 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>: | ||
** gastrointestinal symptoms such as diarrhea and abdominal pain | **[[gastrointestinal]] symptoms such as [[diarrhea]] and [[abdominal pain]] | ||
** elevated liver enzymes | ** elevated [[liver enzymes]] | ||
*A rapid drop in the T helper cell/suppressor cell ratio | *A rapid drop in the [[T helper cell]]/[[Suppressor T cells|suppressor cell]] [[ratio]] | ||
* The presence of degenerate keratinocytes at all levels of the epidermis and associated with adjacent lymphocytes (satellite cell necrosis) in AGVHD <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> in contrast to the presence of squamous syringometaplasia which suggests PPE <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> | * The presence of [[degenerate]] [[Keratinocyte|keratinocytes]] at all levels of the [[Epidermis (skin)|epidermis]] and associated with adjacent [[Lymphocyte|lymphocytes]] ([[satellite cell]] [[necrosis]]) in [[GVHD|AGVHD]] <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> in contrast to the presence of [[squamous]] [[Metaplasia|syringometaplasia]] which suggests PPE <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> | ||
However, histologic features of both diseases are identical in early stages and serial biopsies may be needed to distinguish these two entities. <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> | However, [[histologic]] features of both diseases are identical in early stages and serial [[Biopsy|biopsies]] may be needed to distinguish these two entities. <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> | ||
In addition, both disorders may be seen simultaneously in a patient. | In addition, both [[disorders]] may be seen simultaneously in a patient. | ||
==References== | ==References== | ||
Revision as of 18:29, 16 July 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mandana Chitsazan, M.D. [2]
Overview
PPE must be differentiated from Graft-Versus-Host Disease (GVHD).
Differentiating palmar plantar erythrodysesthesia from other Diseases
The two most important differential diagnoses of PPE is Acute Graft-Versus-Host Disease (AGVHD) in patients who have received a bone marrow transplant
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.
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 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.
- ↑ 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.