Palmar plantar erythrodysesthesia pathophysiology: Difference between revisions

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Revision as of 15:11, 26 June 2019

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

Overview

The exact pathogenesis of [disease name] is not fully understood.

OR

It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].

OR

[Pathogen name] is usually transmitted via the [transmission route] route to the human host.

OR

Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.

OR

[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].

OR

The progression to [disease name] usually involves the [molecular pathway].

OR

The pathophysiology of [disease/malignancy] depends on the histological subtype.

Pathophysiology

Physiology

The normal physiology of [name of process] can be understood as follows:

Pathogenesis

The exact pathogenesis of [disease name] is not completely understood.

OR

It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
The progression to [disease name] usually involves the [molecular pathway].
The pathophysiology of [disease/malignancy] depends on the histological subtype.

Genetics

[Disease name] is transmitted in [mode of genetic transmission] pattern.

OR

Genes involved in the pathogenesis of [disease name] include:

[Gene1]
[Gene2]
[Gene3]

OR

The development of [disease name] is the result of multiple genetic mutations such as:

[Mutation 1]
[Mutation 2]
[Mutation 3]

Associated Conditions

Conditions associated with [disease name] include:

[Condition 1]
[Condition 2]
[Condition 3]

Gross Pathology

On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

Microscopic Pathology

On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].

References

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Palmar plantar erythrodysesthesia}}
-{{CMG}}, {{AE}}: [[Mandana Chitsazan, M.D.|Mandana Chitsazan, M.D.,]] [[Zain Fatiwala M.D.]]
+{{CMG}}; {{AE}}
 ==Overview==
-The pathophysiologic mechanism of Palmar Plantar Erythrodysesthesia is under active investigation and different mechanisms have been postulated.<ref name="pmid2061446" /> Factors that have been implicated involve rapid cell division in palms and soles, gravitational forces, vascular anatomy peculiar to these areas and temperature gradients that may be present in distal end of extremities. The higher drug concentration in the eccrine glands of palms and soles also play a role in this condition. PPE Biopsies appear histologically nonspecific, but a consistenty toxic reaction is seen.<ref name="pmid2061466" />
+The exact pathogenesis of [disease name] is not fully understood.
-In Palmar Plantar Erythrodysesthesia associated with Pegylated liposomal doxorubicin (PLD), it has been determined that the drug is present is deposited in sweat then smeared onto the skin surfaces. The sweat glands are present in high concentration on the palms and soles. The drug then infiltrates the stratum corneum which is a thick layer in the body. This layer acts as a reservoir for the drug leading to the symptoms of PPE.<ref name="pmid23969763" />
+OR
+It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
+OR
+[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
+OR
+Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
+OR
+[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
+OR
+The progression to [disease name] usually involves the [molecular pathway].
+OR
+The pathophysiology of [disease/malignancy] depends on the histological subtype.
 ==Pathophysiology==
-The exact pathogenesis of PPE is not completely understood. Existing theories are based on the fact that only the hands and feet are involved and posit the role of temperature differences, vascular anatomy, differences in the types of cells (rapidly dividing epidermal cells and eccrine glands).
+===Physiology===
+The normal physiology of [name of process] can be understood as follows:
+===Pathogenesis===
+*The exact pathogenesis of [disease name] is not completely understood.
+OR
+*It is understood that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
+*[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
+*Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
+*[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
+*The progression to [disease name] usually involves the [molecular pathway].
+*The pathophysiology of [disease/malignancy] depends on the histological subtype.
+==Genetics==
+[Disease name] is transmitted in [mode of genetic transmission] pattern.
+OR
+Genes involved in the pathogenesis of [disease name] include:
+*[Gene1]
+*[Gene2]
+*[Gene3]
+OR
+The development of [disease name] is the result of multiple genetic mutations such as:
-The pathophysiologic mechanism of Palmar Plantar Erythrodysesthesia is under active investigation and different mechanisms have been postulated.<ref name="pmid2061446">{{cite journal| author=Baack BR, Burgdorf WH| title=Chemotherapy-induced acral erythema. | journal=J Am Acad Dermatol | year= 1991 | volume= 24 | issue= 3 | pages= 457-61 | pmid=2061446 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2061446  }}</ref> Factors that have been implicated involve rapid cell division in palms and soles, gravitational forces, vascular anatomy peculiar to these areas and temperature gradients that may be present in distal end of extremities. The higher drug concentration in the eccrine glands of palms and soles also play a role in this condition. PPE Biopsies appear histologically nonspecific, but a consistenty toxic reaction is seen.<ref name="pmid2061466">{{cite journal| author=Duvernoy O, Malm T, Thuomas KA, Larsson SG, Hansson HE| title=CT and MR evaluation of pericardial and retrosternal adhesions after cardiac surgery. | journal=J Comput Assist Tomogr | year= 1991 | volume= 15 | issue= 4 | pages= 555-60 | pmid=2061466 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2061466  }}</ref>
+*[Mutation 1]
+*[Mutation 2]
+*[Mutation 3]
-In Palmar Plantar Erythrodysesthesia associated with Pegylated liposomal doxorubicin (PLD), it has been determined that the drug is present is deposited in sweat then smeared onto the skin surfaces. The sweat glands are present in high concentration on the palms and soles. The drug then infiltrates the stratum corneum which is a thick layer in the body. This layer acts as a reservoir for the drug leading to the symptoms of PPE.<ref name="pmid23969763">{{cite journal| author=Lademann J, Martschick A, Kluschke F, Richter H, Fluhr JW, Patzelt A et al.| title=Efficient prevention strategy against the development of a palmar-plantar erythrodysesthesia during chemotherapy. | journal=Skin Pharmacol Physiol | year= 2014 | volume= 27 | issue= 2 | pages= 66-70 | pmid=23969763 | doi=10.1159/000351801 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23969763  }}</ref>
+==Associated Conditions==
+Conditions associated with [disease name] include:
-In BMT patients, there is a 35% incidence of PPE and may be due to the use of high doses of chemotherapy with addition of total body irradiation.<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>
+*[Condition 1]
-===Associated Conditions===
+*[Condition 2]
-Palmar Plantar Erythrodysesthesia is commonly associated with chemotherapy that is used for the treatment of different cancers.
+*[Condition 3]
-===Gross Pathology===
+==Gross Pathology==
-PPE commonly affects the palms more commonly than the soles. The lesion starts as just a sensation in the palms and soles, progressing to painful, tingling, symmetric, well-demarcated swelling and erythematous plaques. This is then followed by a desquamative phase that happens on resolution.<ref name="urlAcral Erythema - Holland-Frei Cancer Medicine - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK12891/ |title=Acral Erythema - Holland-Frei Cancer Medicine - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
+On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
-===Microscopic Pathology===
+==Microscopic Pathology==
-On histopathology non-specific features seen in Palmar Plantar Erythrodysesthesia. Features include<ref name="pmid21537373">{{cite journal| author=Farr KP, Safwat A| title=Palmar-plantar erythrodysesthesia associated with chemotherapy and its treatment. | journal=Case Rep Oncol | year= 2011 | volume= 4 | issue= 1 | pages= 229-35 | pmid=21537373 | doi=10.1159/000327767 | pmc=3085037 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21537373  }}</ref>:
+On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
-* Vacuolar degenration of the basal cell layer
-* Mild spongiosis, keratinocytes necrosis
-* Papillary dermal edema
-* Lymphocytic infiltrates
-* Partial separation of epidermis from the dermis
-* Dermis shows perivascular infiltrates made up of eosinphils and lymphocytes
-* May have presence of eccrine squamous syringometaplasia or netruophilic eccrine hidradenitis.
-* Some data suggests that small-fibre neuropathy may cause the pain and dysesthesia.
 ==References==