Palmar plantar erythrodysesthesia differential diagnosis
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
The two most important differential diagnoses of PPE is Acute Graft-Versus-Host Disease (AGVHD) in patients who have received a bone marrow transplant
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.
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.