Palmar plantar erythrodysesthesia differential diagnosis: Difference between revisions
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** 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 | |||
* The presence of degenerate keratinocytes at all levels of the epidermis and associated with adjacent lymphocytes (satellite cell necrosis) in AGVHD< | * 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> | ||
However, histologic features of both diseases are identical in early stages and serial biopsies may be needed to distinguish these two entities< | 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> | ||
In addition, both disorders may be seen simultaneously in a patient. | In addition, both disorders may be seen simultaneously in a patient. | ||
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==References== | ==References== | ||
{{reflist|3}} | {{reflist|3}} | ||
Revision as of 16:25, 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 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.
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
- ↑ 1.0 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.