Localized green pigmentation in a patient with hyperbilirubinemia

Allegue, F.; Hermo, José Antonio; Fachal, C.

doi:10.1016/s0190-9622(96)90518-6

Cited by 26 publications

(17 citation statements)

References 4 publications

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“…Green pigmentation on the palms and soles in patients with hyperbilirubinemia is a rare condition, with only 5 reported cases in the literature. [1][2][3][4] Previous articles have reported that the green pigmentations are mainly along dermatoglyphic ridges where the eccrine sweat glands open, 1,2,4 as in our patient. In addition, all reported patients had cutaneous distribution only on palms and soles, the most abundant areas of sweat glands.…”

Section: Discussionsupporting

confidence: 60%

“…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%

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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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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Green Pigmentation on the Palms and Soles

Triwongwaranat¹,

Kasemsarn²,

Boonchai³

2013

JAMA Dermatol

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“…4 The differential diagnosis includes: hyperbilirubinemia, Pseudomonas infection, bleeding diathesis (red sweat, hematohidrosis), alkaptonuria (ochronosis), and poisoning. 6,8,9 Wood's lamp examination of colored sweat may be positive. A more refined test involves autofluorescence of clothing fibers in contact with the secretions using a standard UV microscope.…”

Section: Etiology and Diagnosismentioning

confidence: 99%

Isolated Areolar Apocrine Chromhidrosis

Griffith

2005

Pediatrics

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ABSTRACT. A case of isolated areolar apocrine chromhidrosis in an 11-year-old female is presented. This is the youngest case cited in Medline. The goal of this review is to increase awareness of apocrine chromhidrosis among primary care providers and to discuss treatment. Capsaicin cream 0.025% is a proven treatment that may reduce the potential psychological impact and embarrassment that patients experience.

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“…The spontaneous appearance of green discoloration of the hair, skin, and nails is unusual 4 . Differential diagnoses include granulocytic sarcoma, poisoning (such as by arsenic), acute pancreatitis (Grey Turner and Cullen signs with the appearance of ecchymotic patches on the abdomen), eccrine chromhidrosis (which may cause yellow, blue, black, or green discoloration), and chronic liver disease.…”

Section: Discussionmentioning

confidence: 99%

“…Although pompholyx is a 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 4, 8. Inflammatory, spongiotic vesicles may induce rupture of neighboring sweat ducts containing high bilirubin, resulting in bilious-appearing vesicles.…”

Section: Discussionmentioning

confidence: 99%