Coalescing Green and Yellow Papules on the Feet

Fung, Maxwell A.; LeBoit, Philip E.; Maibach, Howard I.

doi:10.1001/archderm.136.1.113

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…In addition, although two cases report positive bilirubin staining on Hall's or Fouchet stain [3,5], in two patients, the stains were negative [4,6], as with our case. This may relate to the fact that the bilirubin stain has not been optimized in skin.…”

Section: Discussionsupporting

confidence: 68%

“…Of the now seven reported cases of eccrine chromhidrosis in the setting of hyperbilirubinemia, all occurred on the palms and/or soles of men in the setting of severe jaundice, high fevers, and thickened stratum corneum of the affected area (Table 1) [2][3][4][5][6]. Total bilirubin at time of eruption ranged from 12.07 to 34.7 mg/dl (ref range 0.3-1 mg/dl), and direct bilirubin ranged from 7.97 to 25.5 (ref range 0-0.3 mg/dl).…”

Section: Discussionmentioning

confidence: 99%

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Eccrine chromhidrosis secondary to hyperbilirubinemia

Romero²

2015

Dermatology Online Journal

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Background: Eccrine chromhidrosis, or colored eccrine sweating, may be caused by contamination of sweat by dyes, pigmentation from microorganisms, or more rarely, hyperbilirubinemia. Pigment usually affects the palms and soles, where abundant sweat glands are found.Purpose, Material and Methods: We report a unique case of eccrine chromhidrosis in the setting of hyperbilirubinemia and review the current literature available on PubMed of previously reported cases.Results: Six patients with chromhidrosis have been previously reported in the setting of significant hyperbilirubinemia, in association with fever and thickened stratum corneum.Conclusions: Eccrine chromhidrosis secondary to hyperbilirubinemia is very rare, but can be diagnosed on the basis of classic clinical findings, dermoscopic examination, and negative tissue cultures.

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Section: Discussionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Eccrine chromhidrosis secondary to hyperbilirubinemia

Romero²

2015

Dermatology Online Journal

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“…Nevertheless, not all previously reported cases showed positive results for bile stain. [2][3][4] This may be due to the fact that techniques for detection of bilirubin metabolites in the skin are not available. Kanzaki and Tsuda 1 proposed 3 precipitating factors for this condition, including increase level of water-soluble direct bilirubin, high fever, and a thick horny layer of skin.…”

Section: Discussionmentioning

confidence: 99%

Green Pigmentation on the Palms and Soles

Triwongwaranat¹,

Kasemsarn²,

Boonchai³

2013

JAMA Dermatol

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A man in his 50s presented with abrupt-onset asymptomatic green and brown pigmented lesions on both his palms and soles (Figure, A). He had had progressive jaundice for a month and was recently diagnosed as having advanced intrahepatic cholangiocarcinoma. The cutaneous eruption developed 3 days after a high-grade fever during admission for palliative endoscopic retrograde cholangiopancreatography with metallic stent insertion. The investigation for cause of fever showed influenza A infection. He denied history of contact with any greenish substances on his palms and soles during admission. His sweat was colorless.Physical examination revealed generalized marked jaundice and bilateral symmetrical greenish brown macules and patches on hyperkeratotic palms and soles. The potassium hydroxide examination and Gram stain results were negative for any organisms. Laboratory tests showed a total to direct bilirubin level of 32.7/ 25.5 mg/dL; aspartate aminotransferase level of 93 U/L; alanine aminotransferase level of 82 U/L; and alkaline phosphatase level of 973 U/L. (To convert bilirubin to micromoles per liter, multiply by 17.104; to convert asparatate aminotransferase, alanine aminotransferase, and alkaline phosphatase to microkatals per liter, multiply by 0.0167.) Figure, B, shows the dermatoscopic finding of peeling skin. An incisional biopsy specimen from a nondesquamated greenish brown patch on the left palm, 1 day after the appearance of lesions, was stained with hematoxylin-eosin (Figure, C).

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“…Other causes of green-pigmented lesions, including pseudomonas infection and exogenous staining that can be excluded by negative Gram stain result and the absence of greenish substance exposure, respectively (3). Green pigmentation on the palms and soles in patients with hyperbilirubinemia is a rare condition, with only 6 reported cases in the literature (1,(3)(4)(5)(6). Previous articles have reported that the green pigmentations are mainly along dermatoglyphic ridges where the eccrine sweat glands open (4,6,7,9).…”

Section: Discussionmentioning

confidence: 99%