Palmar plantar erythrodysesthesia differential diagnosis: Difference between revisions

Jump to navigation Jump to search
Tag: Replaced
Line 10: Line 10:




{| class="wikitable"
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical Characteristics
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Clinical manifestation
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other clues to the diagnosis
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Histopathology
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Additional diagnostic clues
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Cutaneous T cell lymphoma]]/[[Mycosis fungoides]]<ref name="urlMycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute">{{cite web |url=https://www.cancer.gov/types/lymphoma/patient/mycosis-fungoides-treatment-pdq |title=Mycosis Fungoides and the Sézary Syndrome Treatment (PDQ®)—Patient Version - National Cancer Institute |format= |work= |accessdate=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" | x1
|
| style="background: #DCDCDC; padding: 5px; text-align: center;" | x2
* '''Premycotic phase:''' A scaly, red [[rash]] in areas of the [[body]] that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years.
| style="background: #DCDCDC; padding: 5px; text-align: center;" | x3
* '''Patch phase:''' Thin, [[erythematous]], [[eczema]]-like rash.
| style="background: #DCDCDC; padding: 5px; text-align: center;" | x4
* '''[[Plaque]] phase:''' Small raised [[Bumps on skin|bumps]] ([[Papule|papules]]) or hardened [[lesions]] on the skin, which may be [[erythematous]].
* '''[[Tumor]] phase:''' Tumors form on the [[skin]]. [[Infection]] secondary to [[Ulcer|ulcers]].
|
* [[Epidermis (skin)|Epidermal]] [[atrophy]] or poikiloderma
 
* Generalized [[itching]] ([[pruritus]])
* [[Pain]] in the affected area of the skin
* [[Insomnia]]
* Red ([[erythematous]]) patches scattered over the [[skin]] of the [[trunk]] and the [[extremities]]
* Tumor-like lobulated outgrowths form on the skin in the latter phase of the disease
* [[Weight loss]]
* [[Lymphadenopathy]]
* [[Malaise]] and [[fatigue]]
* [[Anemia]]
* May progress to [[Sezary syndrome]] (skin involvement plus hematogenous dissemination)
|
* [[Sezary syndrome]]
|
[[Image:Mycosis_fungoides.JPG|200px|courtesy of wikipedia.org]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis rosea]]<ref name="pmid27512182">{{cite journal |vauthors=Mahajan K, Relhan V, Relhan AK, Garg VK |title=Pityriasis Rosea: An Update on Etiopathogenesis and Management of Difficult Aspects |journal=Indian J Dermatol |volume=61 |issue=4 |pages=375–84 |year=2016 |pmid=27512182 |pmc=4966395 |doi=10.4103/0019-5154.185699 |url=}}</ref>
|
* Pink or salmon in color, which may be scaly; referred to as "herald patch"
* Oval shape
* Long axis oriented along the cleavage lines
* Distributed on the [[trunk]] and [[proximal extremities]]
* Squamous marginal collarette and a “fir-tree” or “Christmas tree” distribution on  posterior trunk
* Secondary to [[viral infection]]<nowiki/>s
* Resolves spontaneously after 6-8 weeks
|
* Preceded by a prodrome of:
** [[Sore throat]]
** [[Gastrointestinal tract|Gastrointestinal]] disturbance
** [[Fever]]
** [[Arthralgia]]
|
* Infection by any of the following:<ref name="pmid19997691">{{cite journal |vauthors=Prantsidis A, Rigopoulos D, Papatheodorou G, Menounos P, Gregoriou S, Alexiou-Mousatou I, Katsambas A |title=Detection of human herpesvirus 8 in the skin of patients with pityriasis rosea |journal=Acta Derm. Venereol. |volume=89 |issue=6 |pages=604–6 |year=2009 |pmid=19997691 |doi=10.2340/00015555-0703 |url=}}</ref>
** [[Human herpesvirus 6|HHV-6]]
** [[HHV-7]]
** [[HHV-8]]
|
[[Image:Pityriasisrosea.png|200px|courtesy of https://commons.wikimedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Pityriasis lichenoides chronica]]
|
* Recurrent [[lesions]] are usually less evenly scattered than in cases of psoriasis
* Brownish red or orange-brown in color
* [[Lesions]] are capped by a single detachable, opaque, mica-like scale
* Often leave [[Hypopigmented area|hypopigmented]] [[Macule|macules]]
|
* High [[fever]]
* [[Malaise]]
* [[Myalgias]]
* [[Paraesthesia]]
* [[Pruritis|Pruritus]]
|
* Infection by any of the following:<ref name="pmid9109005">{{cite journal |vauthors=Smith KJ, Nelson A, Skelton H, Yeager J, Wagner KF |title=Pityriasis lichenoides et varioliformis acuta in HIV-1+ patients: a marker of early stage disease. The Military Medical Consortium for the Advancement of Retroviral Research (MMCARR) |journal=Int. J. Dermatol. |volume=36 |issue=2 |pages=104–9 |year=1997 |pmid=9109005 |doi= |url=}}</ref>
** [[Epstein Barr virus|Epstein-Barr virus]] (EBV)
** ''[[Toxoplasma gondii]]''
** [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
|
[[Image:PLEVA2.jpg|200px|courtesy of http://www.regionalderm.com]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Nummular dermatitis]]<ref name="pmid23517392">{{cite journal |vauthors=Jiamton S, Tangjaturonrusamee C, Kulthanan K |title=Clinical features and aggravating factors in nummular eczema in Thais |journal=Asian Pac. J. Allergy Immunol. |volume=31 |issue=1 |pages=36–42 |year=2013 |pmid=23517392 |doi= |url=}}</ref>
|
* Multiple coin-shaped [[Eczematous Scaling|eczematous]] [[lesions]]
* Commonly affecting the [[extremities]] (lower>upper) and [[trunk]]
* May ooze [[fluid]] and become dry and crusty
|
* Often appears after a skin injury, such as a [[burn]], [[abrasion]] (from friction), or [[insect bite]]
* [[Lesions]] commonly relapse after occasional remission or may persist for long periods
* [[Pruritis|Pruritus]]
|
* Associated with:
** Dry skin
** Emotional stress
** [[Allergens]] (rubber chemicals, [[formaldehyde]], [[neomycin]], chrome, [[Mercury (element)|mercury]], and [[nickel]])
** [[Staphylococcus]] infection
** Seasonal variation
** [[Alcohol]]
** [[Drugs]]
** [[Atopy]]
|
[[Image:Nummular dermatitis dry.jpg|200px|courtesy of your-doctor.net dermatology atlas]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Secondary syphilis]]<ref name="urlSTD Facts - Syphilis">{{cite web |url=https://www.cdc.gov/std/syphilis/stdfact-syphilis.htm |title=STD Facts - Syphilis |format= |work= |accessdate=}}</ref>
|
* Round, coppery, red colored [[lesions]] on palms and soles
* [[Papule|Papules]] with collarette of scales
|
* [[Fever]]
* [[Lymphadenopathy|Generalized lymphadenopathy]]
* [[Sore throat]]
* [[Hair loss|Patchy hair loss]]
* [[Headaches|Headache]]
* [[Weight loss]]
* [[Myalgia]]
* [[Fatigue]]
|
* Associated with:
** [[Condyloma latum|Condylomata lata]]
** Corona verinata
** Positive [[Venereal disease research laboratory (VDRL) test|VDRL]] test
|
[[Image:Secondary_Syphilis.jpg|200px|courtesy of wikipedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bowen’s disease]]<ref name="pmid28523295">{{cite journal |vauthors=Neagu TP, Ţigliş M, Botezatu D, Enache V, Cobilinschi CO, Vâlcea-Precup MS, GrinŢescu IM |title=Clinical, histological and therapeutic features of Bowen's disease |journal=Rom J Morphol Embryol |volume=58 |issue=1 |pages=33–40 |year=2017 |pmid=28523295 |doi= |url=}}</ref>
|
* [[Erythematous]], small, scaly plaque, which enlarges erratically over time
* Scale is usually yellow or white and it is easily detachable without any [[bleeding]]
* Well-defined margins
|
* [[Pruritis|Pruritus]]
* [[Pain]]
* Bleeding [[lesions]]
|
* Associated with:<ref name="pmid25201325">{{cite journal |vauthors=Murao K, Yoshioka R, Kubo Y |title=Human papillomavirus infection in Bowen disease: negative p53 expression, not p16(INK4a) overexpression, is correlated with human papillomavirus-associated Bowen disease |journal=J. Dermatol. |volume=41 |issue=10 |pages=878–84 |year=2014 |pmid=25201325 |doi=10.1111/1346-8138.12613 |url=}}</ref>
** [[Erythroplasia of Queyrat]] ([[Bowen's disease]] of the [[penis]])
** [[Squamous cell carcinoma]]
** Solar radiation and [[ultraviolet]] (UV) exposure
** [[Radiation therapy|Radiotherapy]]
** [[Immunosuppression]]
** [[Arsenic]] exposure
** [[Human papillomavirus|Human papilloma virus]] (HPV) type 16
** [[Polyomavirus|Merkel cell polyomavirus]]
** [[Sjögren's syndrome|Sjögren’s syndrome]]
|
[[Image:Bowen.jpg|200px|courtesy of wikipedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Exanthematous pustulosis]]<ref name="pmid26354880">{{cite journal |vauthors=Szatkowski J, Schwartz RA |title=Acute generalized exanthematous pustulosis (AGEP): A review and update |journal=J. Am. Acad. Dermatol. |volume=73 |issue=5 |pages=843–8 |year=2015 |pmid=26354880 |doi=10.1016/j.jaad.2015.07.017 |url=}}</ref>
|
* Numerous small, primarily non-follicular, sterile [[pustules]], arising within large areas of [[Edema|edematous]] [[erythema]]
|
* [[Fever]]
* [[Leukocytosis]]
* Intracorneal, subcorneal, and/or intraepidermal [[pustules]] with [[papillary]] [[dermal]] [[edema]] containing [[neutrophils]] and [[eosinophils]]
|
* Associated with:<ref name="pmid12466124">{{cite journal |vauthors=Schmid S, Kuechler PC, Britschgi M, Steiner UC, Yawalkar N, Limat A, Baltensperger K, Braathen L, Pichler WJ |title=Acute generalized exanthematous pustulosis: role of cytotoxic T cells in pustule formation |journal=Am. J. Pathol. |volume=161 |issue=6 |pages=2079–86 |year=2002 |pmid=12466124 |pmc=1850901 |doi=10.1016/S0002-9440(10)64486-0 |url=}}</ref>
** [[Antibiotics]] ([[Penicillin|penicillins]], [[sulfonamides]], [[tetracyclines]])
** [[Carbamazepine]]
** [[Calcium channel blocker|Calcium channel blockers]] ([[Diltiazem]])
** [[Hydroxychloroquine]]
|
[[Image:Acute_generalized_exanthematous_pustulosis.jpg|200px|commons.wikimedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lichen planus|Hypertrophic lichen planus]]<ref name="pmid27222766">{{cite journal |vauthors=Ankad BS, Beergouder SL |title=Hypertrophic lichen planus versus prurigo nodularis: a dermoscopic perspective |journal=Dermatol Pract Concept |volume=6 |issue=2 |pages=9–15 |year=2016 |pmid=27222766 |pmc=4866621 |doi=10.5826/dpc.0602a03 |url=}}</ref>
|
* Classically involves shin and ankles and is characterized by [[Hyperkeratosis|hyperkeratotic]] [[Plaque|plaques]] and [[Nodule (medicine)|nodules]] covered by a scale
* [[Lesions]] may transform into [[Hyperkeratosis|hyperkeratotic]] thickened, elevated, purplish or reddish [[Plaque|plaques]] and [[nodules]]
|
* Chronic [[pruritis|pruritus]]
* Scaling
* May be [[asymptomatic]]
|
* Associated with [[Hepatitis C virus]] infection<ref name="pmid19770446">{{cite journal |vauthors=Shengyuan L, Songpo Y, Wen W, Wenjing T, Haitao Z, Binyou W |title=Hepatitis C virus and lichen planus: a reciprocal association determined by a meta-analysis |journal=Arch Dermatol |volume=145 |issue=9 |pages=1040–7 |year=2009 |pmid=19770446 |doi=10.1001/archdermatol.2009.200 |url=}}</ref>
|
[[Image:Lichen_planus2.JPG|200px|courtesy of wikipedia.org]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Sneddon–Wilkinson disease<ref name="pmid9564592">{{cite journal |vauthors=Lutz ME, Daoud MS, McEvoy MT, Gibson LE |title=Subcorneal pustular dermatosis: a clinical study of ten patients |journal=Cutis |volume=61 |issue=4 |pages=203–8 |year=1998 |pmid=9564592 |doi= |url=}}</ref>
|
* [[Flaccid]] [[pustules]] that are often generalized and have a tendency to involve the flexural areas
* Annular configuration
|
* [[Pruritis|Pruritus]]
* May be asymptomatic
|
* Associated with:
** [[Monoclonal gammopathy]], usually an [[IgA]] paraproteinemia<ref name="pmid3056995">{{cite journal |vauthors=Kasha EE, Epinette WW |title=Subcorneal pustular dermatosis (Sneddon-Wilkinson disease) in association with a monoclonal IgA gammopathy: a report and review of the literature |journal=J. Am. Acad. Dermatol. |volume=19 |issue=5 Pt 1 |pages=854–8 |year=1988 |pmid=3056995 |doi= |url=}}</ref>
** [[Crohn's disease]]<ref name="pmid1357895">{{cite journal |vauthors=Delaporte E, Colombel JF, Nguyen-Mailfer C, Piette F, Cortot A, Bergoend H |title=Subcorneal pustular dermatosis in a patient with Crohn's disease |journal=Acta Derm. Venereol. |volume=72 |issue=4 |pages=301–2 |year=1992 |pmid=1357895 |doi= |url=}}</ref>
** [[Osteomyelitis]]
** [[Adalimumab]]<ref name="pmid23489057">{{cite journal |vauthors=Sauder MB, Glassman SJ |title=Palmoplantar subcorneal pustular dermatosis following adalimumab therapy for rheumatoid arthritis |journal=Int. J. Dermatol. |volume=52 |issue=5 |pages=624–8 |year=2013 |pmid=23489057 |doi=10.1111/j.1365-4632.2012.05707.x |url=}}</ref>
|
[[Image:Sneddon wilkinson disease 03.jpeg|200px|courtesy http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=427]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Parapsoriasis|Small plaque parapsoriasis]]<ref name="pmid7026622">{{cite journal |vauthors=Lambert WC, Everett MA |title=The nosology of parapsoriasis |journal=J. Am. Acad. Dermatol. |volume=5 |issue=4 |pages=373–95 |year=1981 |pmid=7026622 |doi= |url=}}</ref>
|
* [[Erythematous]] [[plaques]] with fine scaly surface
* May present with elongated, finger-like patches
* Symmetrical distribution on the flanks
* Known as digitate dermatosis
|
* [[Lesions]] may be [[asymptomatic]]
* May be mildly [[Itch|pruritic]]
* May fade or disappear after sun exposure during the summer season, but typically recur during the winter
|
* May progress to [[mycosis fungoides]]<ref name="pmid16191852">{{cite journal |vauthors=Väkevä L, Sarna S, Vaalasti A, Pukkala E, Kariniemi AL, Ranki A |title=A retrospective study of the probability of the evolution of parapsoriasis en plaques into mycosis fungoides |journal=Acta Derm. Venereol. |volume=85 |issue=4 |pages=318–23 |year=2005 |pmid=16191852 |doi=10.1080/00015550510030087 |url=}}</ref>
|
[[Image:Small_plaque_parapsoriasis.jpg|200px|courtesy http://www.regionalderm.com]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Intertrigo]]<ref name="pmid16156342">{{cite journal |vauthors=Janniger CK, Schwartz RA, Szepietowski JC, Reich A |title=Intertrigo and common secondary skin infections |journal=Am Fam Physician |volume=72 |issue=5 |pages=833–8 |year=2005 |pmid=16156342 |doi= |url=}}</ref>
|
* Red and fleshy looking [[lesion]] in [[skin]] folds
* [[Itching]]
* Oozing
* May be sore
|
* [[Pruritis|Pruritus]]
* Musty odor
|
* Associated with:
** [[Infections]] (Fungal, bacterial, viral)
** [[Allergies]]
** [[Diabetes Mellitus|Diabetes]]
** [[Obesity]]
|
[[Image:Axillary_intertrigo.png|200px|courtesy of cdc.gov]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Langerhans cell histiocytosis]]<ref name="pmid18577030">{{cite journal |vauthors=Satter EK, High WA |title=Langerhans cell histiocytosis: a review of the current recommendations of the Histiocyte Society |journal=Pediatr Dermatol |volume=25 |issue=3 |pages=291–5 |year=2008 |pmid=18577030 |doi=10.1111/j.1525-1470.2008.00669.x |url=}}</ref>
|
* Scaling and crusting of [[scalp]]
|
* Pathological fractures<ref name="pmid1636041">{{cite journal |vauthors=Stull MA, Kransdorf MJ, Devaney KO |title=Langerhans cell histiocytosis of bone |journal=Radiographics |volume=12 |issue=4 |pages=801–23 |year=1992 |pmid=1636041 |doi=10.1148/radiographics.12.4.1636041 |url=}}</ref>
* Visceromegaly ([[hepatomegaly]], [[spleenomegaly]])
* [[Chronic cough, severe cold|Chronic cough]]
* [[Dyspnea]]<ref name="pmid17527085">{{cite journal |vauthors=Sholl LM, Hornick JL, Pinkus JL, Pinkus GS, Padera RF |title=Immunohistochemical analysis of langerin in langerhans cell histiocytosis and pulmonary inflammatory and infectious diseases |journal=Am. J. Surg. Pathol. |volume=31 |issue=6 |pages=947–52 |year=2007 |pmid=17527085 |doi=10.1097/01.pas.0000249443.82971.bb |url=}}</ref>
* [[Lymphadenopathy]]
|
* Associated with:
** [[Diabetes insipidus]]<ref name="pmid16047354">{{cite journal |vauthors=Grois N, Pötschger U, Prosch H, Minkov M, Arico M, Braier J, Henter JI, Janka-Schaub G, Ladisch S, Ritter J, Steiner M, Unger E, Gadner H |title=Risk factors for diabetes insipidus in langerhans cell histiocytosis |journal=Pediatr Blood Cancer |volume=46 |issue=2 |pages=228–33 |year=2006 |pmid=16047354 |doi=10.1002/pbc.20425 |url=}}</ref>
** [[Pancytopenia]]
|
[[Image:Langerhan_cell_histiocytosis.jpg|200px|courtesy http://www.regionalderm.com]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tinea manuum]]/pedum/capitis<ref name="pmid15050029">{{cite journal |vauthors=Al Hasan M, Fitzgerald SM, Saoudian M, Krishnaswamy G |title=Dermatology for the practicing allergist: Tinea pedis and its complications |journal=Clin Mol Allergy |volume=2 |issue=1 |pages=5 |year=2004 |pmid=15050029 |pmc=419368 |doi=10.1186/1476-7961-2-5 |url=}}</ref>
|
* Scaling, flaking, and sometimes blistering of the affected areas
* Hair loss with a black dot on scalp in case of [[tinea capitis]]
|
* [[Pruritis|Pruritus]]
* [[KOH]] preparation of the [[lesions]] confirms [[fungal infection]]
|
* Associated with:
** [[Diabetes mellitus|Diabetes]]
** [[Immunosupression]]
** Intimate contact with infected person
** May lead to [[asthma]] exacerbation
|
[[Image:Tinea_pedis.jpg|200px|courtesy regionalderm.com]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seborrheic dermatitis]]
|
* [[Papulosquamous]], scaly, flaky, [[itchy]], and red [[rash]] found particularly at [[sebaceous gland]]-rich areas of the body
|
* [[Pruritus]]
|
* Associated with:<ref name="pmid16848386">{{cite journal |vauthors=Schwartz RA, Janusz CA, Janniger CK |title=Seborrheic dermatitis: an overview |journal=Am Fam Physician |volume=74 |issue=1 |pages=125–30 |year=2006 |pmid=16848386 |doi= |url=}}</ref>
** [[AIDS]]
** [[Stress]]<ref name="pmid18033062">{{cite journal |vauthors=Misery L, Touboul S, Vinçot C, Dutray S, Rolland-Jacob G, Consoli SG, Farcet Y, Feton-Danou N, Cardinaud F, Callot V, De La Chapelle C, Pomey-Rey D, Consoli SM |title=[Stress and seborrheic dermatitis] |language=French |journal=Ann Dermatol Venereol |volume=134 |issue=11 |pages=833–7 |year=2007 |pmid=18033062 |doi= |url=}}</ref>
** [[Fungal infection]]
** [[Fatigue]]
** [[Sleep deprivation]]
** Change of season
** [[Parkinson's disease|Parkinson's]] disease
** [[Biotin]] deficiency
|
[[Image:Seborrhoeic_dermatitisnew.jpg|200px|courtesy of wikipedia.com]]
|}
|}



Revision as of 23:01, 30 July 2019

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
x1 x2 x3 x4

References