Palmar plantar erythrodysesthesia differential diagnosis
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
- ↑ 1.0 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.