Green palmoplantar vesicular eruption in a patient with hyperbilirubinemia

Infectious Pseudochromhidrosis: A Case Report and Literature Review

“…There are reports of orange (9), red (10), blue (8,9,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), green (13,21), and brown/black (22)(23)(24)(25)(26) sweat. Eccrine chromhidrosis is generalized discolouration that occurs secondary to ingestion of water-soluble drugs (2,27,28), dyes (29)(30)(31), or due to breakdown products from eccrine glands (2,(32)(33)(34)(35). Eccrine glands are distributed with varying density over almost the entire integument and excrete large amounts of sweat, containing mostly water and electrolytes (1,3).…”

Green palmar discoloration in a patient with primary sclerosis cholangitis: eccrine chromhidrosis or pompholyx?

“…Previous articles have reported that the green pigmentations are mainly along dermatoglyphic ridges where the eccrine sweat glands open (4,6,7,9). The etiology of pompholyx is unknown, but associations with atopy and contact sensitivity have been reported (2,7,8). We describe an unusual case of pompholyx presenting as green palmar vesicles in a patient presenting PSC in terminal cirrhosis stage with severe hyperbilirubinemia.…”

“…Although pompholyx is spongiotic dermatitis, the greenish discoloration of the palmoplantar vesicles seen in our patient cannot be explained by spongiotic changes alone. We hypothesize that this condition occurs because increased water-soluble bilirubin is delivered to the intraepidermal sweat glands of patients with hyperbilirubinemia, where it is deposited into the stratum corneum (1,2,4). Because of the high density of eccrine sweat glands in the palm and sole, pompholyx was initially regarded as being associated with disordered sweat ducts.…”

“…Such involvement of sweat ducts in the pathogenesis of pompholyx may explain the bile-coloured vesicles of our patient. In any patient with hyperbilirubinemia and palmoplantar vesicles, the differential diagnosis should include eccrine chromhidrosis, a rare condition in which pigment from dyes or medications are excreted via the eccrine sweat glands (2,3,9). Three subtypes have been described by Cilliers and de Beer: true eccrine chromhidrosis, pseudo-eccrine chromhidrosis, and apocrine chromhidrosis (10,11).…”

“…To our knowledge, we report the first case of acral green pigmentation: Introduction: Primary sclerosis cholangitis (PSC) is an autoimmune disease of the liver characterized by a progressive course of cholestasis with inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts that can associated to hyperbilirubinemia in complicated or advanced stage. The spontaneous appearance of green discoloration of the hair, skin, and nails is unusual (1,2). There are various causes of cutaneous green discoloration.…”