Palmar plantar erythrodysesthesia differential diagnosis

Overview
Palmar plantar erythrodysesthesia (PPE) is a swelling and numbness of the hands and feet that occurs with chemotherapy, usually with fluorouracil, capecitabine, cytarabine, and doxorubicin.

Differential diagnosis
The problem arises in patients after bone marrow transplants, as the clinical and histologic features of PPE can be similar to cutaneous manifestations of acute (first 3 weeks) graft-versus-host disease. It is important to differentiate PPE, which is benign, from the more dangerous graft-versus-host disease. As time progresses, patients with graft-versus-host disease progress to have other body parts affected, while PPE is limited to hands and feet. Serial biopsies every 3 to 5 days can also be helpful in differentiating the two disorders (Crider et al, 1986).