Palmar plantar erythrodysesthesia differential diagnosis
Palmar plantar erythrodysesthesia Microchapters |
Differentiating Palmar plantar erythrodysesthesia from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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] 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]
- 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.