Sunday, November 16, 2014

Spot Diagnosis # 3

A 90 years old emaciated female with the given image of reddened palmar aspect of her hands. She is known case of metastatic hepatic cancer. She has not applied and colour or mehndi. What is your spot diagnosis?

Palmar redness

Answer:

Diagnosis: Palmar Erythema (PE) due to hepatic CA
What is palmar erythema?
Palmar erythema is a non-specific condition where palms of the hands become red, especially at thenar (at the base of thumb) and hypothenar (at the base of little finger) eminences. Palmar erythema may be normal, may be physiological or may be pathological. It may be primary palmar erythema (e.g. pregnancy, heredity and idiopathic) or secondary palmar erythema (various conditions/diseases).
What causes palmar erythema?
The exact cause of palmar erythema is yet not known. However, some experts are in view that high levels of estrogen in the blood cause palmar erythema as this hormone has been seen raised in cirrhosis of liver and during the pregnancy. It is thought that estrogen increases vascularity, leading to redness of palms. Redness of palms in palmar erythema varies person to person and may extend to the fingers and nail beds.
Which conditions have palmar erythema?
A lot of conditions have palmar erythema as a sign. The following conditions/diseases show PE:
  1. Pregnancy- PE in pregnancy is a type of primary PE and is shown by about 30% of the pregnant women.
  2. Chronic liver disease- About 23% patients with CLD show secondary PE.
  3. Portal hypertension
  4. Polycythemia
  5. Rheumatoid arthritis- More than 60% patients with RA show secondary PE.
  6. Thyrotoxicosis- About 18% patients with thyrotoxicosis show secondary PE.
  7. Eczema or psoriasis
  8. Drug-induced- Drugs such as amiodarone, gemfibrozil, cholestyramine, topiramate and albuterol also cause secondary PE as a side effect. 
  9. Metastatic and primary brain neoplasms- Increased angiogenic factors and estrogens levels in the patients with metastatic and primary brain neoplasms show secondary PE.
  10. Smoking- An environmental cause of PE
  11. Chronic mercury poisoning- An environmental cause of PE
What is the treatment of palmar erythema?
There is no treatment of palmar erythema except treating the cause. Drug-induced PE can be abolished by discontinuing the same drug.

Spot Diagnosis # 2
Keywords: Palmar erythema, PE, Pregnancy, CLD, RA, Rheumatoid arthritis, Hepatic cancer, Metasatic liver cancer, CA liver, Red hands, Palmar redness

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