Palmar plantar erythrodysesthesia differential diagnosis

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. 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. 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.