Palmar plantar erythrodysesthesia differential diagnosis: Difference between revisions

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==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
PPE must be differentiated from Graft-Versus-Host Disease (GVHD) and Stenvens-Johnson Syndrome.


OR
==Differentiating palmar plantar erythrodysesthesia from other Diseases==
The two most important differential diagnoses of PPE:


[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
* Acute Graft-Versus-Host Disease (AGVHD) in patients who have received a bone marrow transplant


==Differentiating [Disease name] from other Diseases==
* Stevens-Johnson syndrome (SJS).
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].


OR


[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
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.  


OR
In differentiating between PPE and AGVHD, the following factors suggest the presence of AGVHD:


As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
* 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>
* 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
* 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<sup>87</sup> in contrast to the presence of squamous syringometaplasia which suggests PPE<sup>86</sup>
 
However, histologic features of both diseases are identical in early stages and serial biopsies may be needed to distinguish these two entities<sup>12</sup>
 
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]===
===Differentiating [disease name] from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]===

Revision as of 16:19, 27 June 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

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 AGVHD87 in contrast to the presence of squamous syringometaplasia which suggests PPE86

However, histologic features of both diseases are identical in early stages and serial biopsies may be needed to distinguish these two entities12

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].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3
Differential Diagnosis 1
Differential Diagnosis 2
Differential Diagnosis 3
Diseases Symptom 1 Symptom 2 Symptom 3 Physical exam 1 Physical exam 2 Physical exam 3 Lab 1 Lab 2 Lab 3 Imaging 1 Imaging 2 Imaging 3 Histopathology Gold standard Additional findings
Differential Diagnosis 4
Differential Diagnosis 5
Differential Diagnosis 6

References

  1. ↑ 1.0 1.1 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.
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