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
Disease
Clinical manifestation
Histopathology
Additional diagnostic clues
Palmar plantar erythrodysesthesia
The areas of well-defined intense erythema and edema
A variable degree of epidermal (keratinocytes) necrosis
Vacuolar degeneration of the basal cell layer of epidermis
Spongiosis
Hyperkeratosis
Lymphohistiocytic infiltrates
Superficial perivascular infiltration of dermis by lymphocytes and eosinophils
Papillary dermal edema
Neutrophilic eccrine hidradenitis
Eccrine squamous syringometaplasia, in severe PPE (WHO grades 3 and 4)
History of chemotherapeutic agent use
Graft-versus-host disease
A diffuse macular erythema whihich may form papules
Histologic features of Graft-versus-host disease and palmar plantar erythrodysesthesia are identical in early stages and serial biopsies may be needed to distinguish these two entities.
Features suggestive of Graft-versus-host disease:
Degenerate keratinocytes at all levels of the epidermis
Adjacent lymphocytes (satellite cell necrosis)
Extracutaneous manifestations of AGVHD, including:
Gastrointestinal symptoms such as diarrhea and abdominal pain
Elevated liver enzymes
Contact dermatitis
Well-demarcated, eczematous eruptions localized to the area of skin that in contact with the culprit allergen
Acute eruption: vesicular
Chronic eruption: lichenified and scaly plaques
Eosinophilic spongiosis
Exocytosis of eosinophils and lymphocytes
History of allergen exposure
Pruritic lesions
Patch testing may help to identify allergens
Palmoplantar plaque psoriasis
Sharply defined erythematous, scaly plaques on the palms and/or soles
Fissures
Acanthosis
Hyperkeratosis
Parakeratosis
Neutrophilic infiltration in the epidermis and stratum corneum (Kogoj pustules and Munro's microabscesses)
Abundant mononuclear cells (mainly myeloid cells and T cells) in the dermis
Pruritus is common
Positive Koebner phenomenon
x1
x2
x3
x4
x1
x2
x3
x4
References