Plantar Erythema Research Articles

Septic Shock

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, potentially life-threatening, drug-induced hypersensitivity reaction that includes skin eruption, hematologic abnormalities, lymphadenopathy, and internal organ involvement. Clinical Description: An 11-year-old boy presented with high-grade intermittent fever and generalized rash for 7 days. He was started on phenytoin 1 month back. On presentation, the child was sick looking with 104°F fever, tachypnea, tachycardia, flushed with bounding pulses, and generalized edema suggestive of septic shock. Distinct diffuse erythematous, maculopapular rash with normal mucosae was noted all over the body with palmar and plantar erythema associated with hepatomegaly and ascites. Investigations showed eosinophilia. Management: The child was managed conservatively for septic shock, followed by withdrawing phenytoin and giving a pulse dose of methylprednisolone, followed by oral prednisolone. Conclusion: In children presenting with prolonged fever and rash with septic shock, DRESS syndrome should be considered differential diagnosis. A strong clinical suspicion and appropriate lab investigations is cornerstone of diagnosis.

Palmar and plantar erythema, pulmonary fibrosis and the anti-synthetase syndrome

Palmar and plantar erythema, pulmonary fibrosis and the anti-synthetase syndrome

Une cause inhabituelle de retard d’acquisition de la marche : l’hidradénite palmo-plantaire idiopathique

Idiopathic palmoplantar hidradenitis is an uncommon neutrophilic dermatosis, occurring in children and young adults. Its pathogenesis is incompletely understood. It is characterized by spontaneous resolution, but it can relapse in 50% of cases. We describe a case of a child with atypical idiopathic hidradenitis remarkable for its impact on his motor development. A 3-year-old boy was admitted to the pediatric unit for etiological assessment of delayed walking. Medullary MRI and TSH were normal. He was referred to a dermatologic consultation for recurrent and painful palmoplantar lesions, giving an equinus antalgic posture. Examination found erythematous tender plantar nodules. The palms were not affected. The exam was otherwise normal. Diagnosis of idiopathic plantar hidradenitis, pressure urticaria, and plantar erythema nodosum were discussed, leading to a skin biopsy. The histopathologic findings of nodular, neutrophilic infiltrates around the eccrine glands confirmed the diagnosis of idiopathic plantar hidradenitis. Anti-inflammatory treatment was given, followed by complete resolution of the lesions, but persistent equinus posture. Idiopathic palmoplantar hidradenitis is an uncommon neutrophilic dermatosis, distinct from neutrophilic eccrine hidradenitis. It corresponds to neutrophilic infiltrates of the eccrine sweat glands. It is more frequently reported in children and young adults with no medical history. Its pathogenesis is not completely explained. The lesions are usually painful, hindering walking for a few days or even delaying it, as for our patient. These lesions typically involute, but they may recur in more than half of the cases. Through this observation, we highlight the atypical impact of idiopathic hidradenitis and the value of a dermatological examination in case of delayed walking.

Reduktion der immunologischen Abstoßungsreaktion in Composite Tissue Allotransplantation durch Hitzeschock-Präkonditionierung

In spite of great advances in the field of composite tissue allotransplantations (CTA), there is still a major need for optimisation in terms of immunosuppression. Heat shock proteins are produced as a reaction of the body during a stress situation. Once elevated, they protect against a second stress and reduce ischaemia-reperfusion injury within transplantations. In the literature the effect of heat shock and HSP70 on rejection after CTA has not been described. The purpose of this experimental study was to examine the effect of heat shock proteins on rejection in a rat model of CTA. Evaluated was the effect of preconditioning by prior heat stress.Brown Norway rats were systemically heated to a core temperature of 42 °C in order to up-regulate HSP70. The expression of HSP70 in muscle was measured by Western blot analysis and showed a peak 24 h after heat shock. Allogeneic hindlimb transplantations were performed between Brown Norway rats (donor) and Lewis rats (recipients). Group 1 (n=12) was preheated 24 h prior to transplantation. In group 2 (n=12) the transplantation was performed without prior heat shock. Group 3 (n=6) was used as a control group with syngeneic hindlimb transplantations between Lewis rats. Postoperatively the appearance of the transplanted hindlimb was evaluated every 12 h. The beginning of rejection was defined when plantar erythema and foot oedema could be observed at the same time. To verify these discrete signs of rejection, the observation was continued for a further 24 h. In this time erythema and oedema spread over the whole transplanted hindlimb. The rat was sacrificed after specimens of skin and muscle had been taken for histological assessment.The rejection in group 1 (with preconditioning heat shock) began after 4.83±0.44 days, in group 2 (without heat shock) already after 3.88±0.53 days. The difference between these groups was significant because of the small standard deviation (Whitney-Mann U test: p<0.01).In our model of allogeneic composite tissue transplantation, a heat shock and subsequent up-regulation of HSP70 led to a significant delay of the immunological rejection. As the graft rejection is an important item influencing the outcome of allogeneic transplantations, these results represent an option to improve the final functional outcome of composite tissue allotransplantations.

小児日本紅斑熱9 例の臨床的検討

To clarify the clinical manifestations of pediatric Japanese spotted fever (JSF), which remain unclear, we retrospectively reviewed the records of 9 consecutive hospitalized children 5 boys and 4 girls aged 0-15 years (median: 2.3) whose diagnosis was patients with JSF who were serologically confirmed from April 2008 to October 2009. We initially studied the polymerase chain reaction (PCR) assay validity for specific Rickettsia japonica DNA in the blood. We also studied febrile duration, the history of contact with tick-infested areas, body temperature, eschars at tick bite sites, skin rash, treatment drugs, and laboratory data. Five of the 9 (56%) had positive PCR tests. Prehospitalization febrile duration was 1-5 days. Five had had contact with tick-infested areas and 4 had not despite living near such areas. Body temperature was 40 degrees C in 7. Only 4 had eschars at bite sites. Characteristic spotted palmar and/or plantar erythema seen in 8 was useful in diagnosis. Laboratory studies showed typical hyponatremia of < 135mEq/L in 6 JSF was diagnosed easily at hospitalization in 7. Diagnosis in a 2-month-old infant proved difficults, however, worsening the child's condition and causing hepatosplenomegaly, thrombocytopenia, anemia, and hyperferritinema. The infant was treated with high-dose gamma-globulin and azithromycin (AZM) followed by minocycline (MINO). Another case was difficult to diagnose due to clinical manifestations consistent with Kawasaki disease. The child was treated with high-dose gamma-globulin and AZM. Three of the 9 were treated with MINO alone and 4 with combined MINO and new quinolones. Fever was resolved within 2 days of treatment in all cases. Our findings show that children with high fever and spotted palmar and/or plantar erythema should be treated immediately for JSF in prevalent areas, even in the absence of eschars.

Advanced aggressive fibromatosis: Effective palliation with chemotherapy

Background. Aggressive fibromatosis (AF) is a locally invasive proliferative disease. The mainstay of treatment is surgery. Chemotherapy may be considered in inoperable AF following failure of hormonal therapy and/or NSAIDs. Material and methods. We conducted a retrospective search of the prospectively maintained Royal Marsden Hospital Sarcoma Unit database to identify patients with AF treated with chemotherapy between 1987 and 2009. Results. Thirty-nine patients, thirty one females and eight males, received one or more lines of chemotherapy. The most frequently employed chemotherapy regimens were methotrexate/vinblastine [MTX/VBL] (18) and pegylated liposomal doxorubicin [PLD] (14). MTX/VBL was administered weekly or every two weeks at MTX 50 mg and VBL 10 mg. Treatment duration ranged from three weeks to one year with a median of 4.5 months. Partial response (PR) was observed in 11% of cases, disease stabilisation (SD) in 60% and progressive disease (PD) in 22%. Time to progression ranged from one month to sixteen years. The main toxicities reported were mucositis (4), peripheral neuropathy (3), vomiting (3), and neutropenia (3). PLD was administered at 40–50 mg/m2 every four weeks, for up to six cycles. PR was achieved in 33% and in the remainder the disease was stable with no progression during treatment. Three (25%) patients have so far progressed after treatment. Symptomatic benefit, especially pain relief, was reported in 86% (12/14) of cases. Main toxicities included palmar plantar erythema (5) and mucositis (4). Discussion. MTX/VBL remains a useful combination but PLD is emerging as a well tolerated and effective systemic therapy in advanced AF.

Liver Palms (Palmar Erythema)

A 48-year-old white woman presented with worsening fatigue, diffuse arthralgias, joint swelling, malaise, and icterus. In view of ongoing joint pains sparing the distal interphalangeal joints, early morning stiffness, strong family history of rheumatoid arthritis, positive rheumatoid factor, and a positive anti-cyclic citrullinated peptide antibody, she was recently diagnosed with rheumatoid arthritis. She had noticed a change in the color of her palms for about a year (Figure). She had no visible plantar erythema. There was no palpable hepatosplenomegaly, caput medusae, or ascites, with complete absence of other cutaneous signs of liver disease. Her liver function tests revealed hyperbilirubinemia, with a total bilirubin of 4.1 mg/dL, and elevated serum transaminases, with an alanine transaminase of 500 units/L and aspartate transaminase of 799 units/L. Her autoantibody profile revealed a positive antinuclear antibody with a titer of (1:640), with a positive anti-smooth muscle antibody titer (1:320), raising the concern for autoimmune hepatitis. She underwent a liver biopsy, which revealed moderately active hepatitis, predominantly acute, with features suggestive of transition to chronicity with bridging necrosis and early fibrosis.

Phase I feasibility study of carboplatin plus capecitabine followed by maintenance capecitabine in patients (pts) with recurrent platinum-sensitive epithelial ovarian cancer (EOC)

5564 Background: In a previous study, we noted a response rate (RR) of 61% for the 3 drug combination of carboplatin, epirubicin and capecitabine in platinum-sensitive recurrent EOC. This combination however resulted in excessive grade (G) 3–4 haematological toxicity (55%) (BJC 2006; 94:74). The current trial therefore assessed the feasibility and efficacy of the 2 drugs, carboplatin and capecitabine as second- or third-line treatment. Methods: Pts were administered carboplatin (AUC5) day 1 and capecitabine at a starting dose of 750 mg/m2 bd, days 1–21, q21 (dose level 1). The capecitabine dose was deescalated to 625 mg/m2 (dose level -1) and 500 mg/m2 (dose level -2) according to toxicity. Pts with an objective response or stable disease received maintenance capecitabine (at the same dose level) for up to 12 months or until progression. Responses were assessed with RECIST criteria and CA-125. Results: 19 of the 20 pts enrolled were evaluable for toxicity and response. Dose-limiting toxicity was observed at dose level 1 (G3 fatigue, G3 diarrhoea, G3 neutropenia of &gt; 14 days; n = 3/5), dose level -1 (G3 angina (n = 2), G3 vomiting, G3 palmar plantar erythema; n = 4/7) and dose level-2 (diarrhoea / fatigue; n = 1/7). One patient had a G3 carboplatin hypersensivity reaction. 8 pts received maintenance capecitabine which was well tolerated. The overall RR was 53% with 10 partial responses and 5 stable diseases. The median progression free survival (PFS) was 6.5 months (m) and the 6mPFS was 63% with 2 pts currently ongoing treatment. The median PFS on maintenance was 3.2 m. Conclusions: The combination was well tolerated at the recommended phase II dose of carboplatin (AUC 5) and capecitabine (500 mg/m2 bd) with partial responses in over half of the cases. [Table: see text]

Syndrome mains-pieds secondaire à la prise de 6-mercaptopurine chez un enfant de quatre ans

Hand-foot syndrome (HFS) is a dose-dependent cutaneous side effect of cytostatic chemotherapy. It has also been described under the names of acral erythema and palmoplantar erythrodysesthesia. We report a case of HFS during treatment of acute lymphoblastic leukemia with 6-mercaptopurine (6-MP) (Purinethol) in a four-year-old child. A four-year-old boy treated for acute lymphoblastic leukemia developed dry and painful palmar and plantar erythema with fissures. The rash began three weeks after up-titration of 6-MP. There was no past history of cutaneous disease and no other potential trigger factors. The rash ceased after 6-MP withdrawal. To our knowledge, this is the first case of HFS due to 6-MP therapy in a child. 6-MP is a major reference drug for the management of acute lymphoblastic leukemia. Numerous cytostatic drugs have been involved in such eruptions.

Severe palmar–plantar erythema in a patient with breast cancer receiving doxorubicin–cyclophosphamide chemotherapy

Internal Medicine JournalVolume 37, Issue 7 p. 505-506 Severe palmar–plantar erythema in a patient with breast cancer receiving doxorubicin–cyclophosphamide chemotherapy M. J. Damasiewicz, M. J. Damasiewicz 1 St Vincent’s Hospital, Melbourne and2Department of Medicine, Warrnambool HospitalWarrnambool, Victoria, AustraliaSearch for more papers by this author 1,2 F. J. M. Chionh, F. J. M. Chionh 1 St Vincent’s Hospital, Melbourne and2Department of Medicine, Warrnambool HospitalWarrnambool, Victoria, AustraliaSearch for more papers by this author 1,2 T. Hayes, T. Hayes 1 St Vincent’s Hospital, Melbourne and2Department of Medicine, Warrnambool HospitalWarrnambool, Victoria, AustraliaSearch for more papers by this author 2 M. J. Damasiewicz, M. J. Damasiewicz 1 St Vincent’s Hospital, Melbourne and2Department of Medicine, Warrnambool HospitalWarrnambool, Victoria, AustraliaSearch for more papers by this author 1,2 F. J. M. Chionh, F. J. M. Chionh 1 St Vincent’s Hospital, Melbourne and2Department of Medicine, Warrnambool HospitalWarrnambool, Victoria, AustraliaSearch for more papers by this author 1,2 T. Hayes, T. Hayes 1 St Vincent’s Hospital, Melbourne and2Department of Medicine, Warrnambool HospitalWarrnambool, Victoria, AustraliaSearch for more papers by this author 2 First published: 04 June 2007 https://doi.org/10.1111/j.1445-5994.2007.01380.xCitations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume37, Issue7July 2007Pages 505-506 RelatedInformation

A phase I/IIa clinical trial of CLAOP21 and CLAOP14 in patients with high grade non-Hodgkins lymphoma and cardiac risk factors

17548 Background: CHOP combination chemotherapy is the most effective and least toxic regimen for high-grade Non-Hodgkin’s-lymphoma (NHL). Doxorubicin, however, presents a problem in patients at risk for cardiotoxicity. Pegliposomal doxorubicin is a liposomal preparation of doxorubicin with minimal cardiotoxicity. In the CLAOP regimen reported here, we substituted conventional doxorubicin in the CHOP regimen by pegliposomal doxorubicin. Methods: An open-label phase I/IIa study was performed evaluating CLAOP21/20 with 20 mg/m2 of pegliposomal doxorubicin every 21 days, and a dose-dense CLAOP14 regimen supported by G-CSF or pegylated G-CSF every 14 days with escalating doses of pegliposomal doxorubicin in elderly high-grade lymphoma patients. Results: A total of 12 patients were enrolled for CLAOP 21/20, and 24 patients for CLAOP 14/20. CLAOP21/20 was well tolerated with a degree of hematotoxicity similar to that reported with regular CHOP. In the CLAOP14 cohort, a trend towards cumulative hematotoxicity. Palmar plantar erythema (PPE) exceeding grade II and other non-hematological toxicities exceeding grade I, except of alopecia, were not observed. A pegliposomal doxorubicin dose of 25 mg/m2 (CLAOP14/25) was associated with dose-limiting haematotoxicity, febrile episodes, and PPE. Both, the 3-weekly and the 2-weekly regimens were active with an overall response rate of 60% and 77%, respectively. Cardiotoxicity attributable to doxorubicin was not observed in any patient. Conclusions: The recommended dose of pegliposomal doxorubicin in the biweekly CLAOP regimen for Phase II/III testing is 20 mg/m2, a regimen that can safely be administered to old patients without apparent cardiotoxicity. [Table: see text]

The effects of capecitabine in Raynaud's disease: a case report

5-Fluorouracil (5-FU) is one of a number of chemotherapeutic agents associated with cardiovascular toxicities, with an incidence ranging from 2% to 10% [1 –3]. Side-effects including angina, arrhythmias, ventricular dysfunction and myocardial infarction, along with the induction and exacerbation of Raynaud’s disease, are well documented. With the increasing use of the oral 5-FU prodrug capecitabine, recent reports suggest that its cardiotoxic incidence is similar to that of 5-FU at 3% [4]. However, at present there is no clear documentation relating to its effects on peripheral vasospasm. This case report is based on a patient who experienced profound deterioration of Raynaud’s disease whilst receiving capecitabine chemotherapy. In March 2003, an 86-year-old man with a long-standing history of Raynaud’s disease was diagnosed with Dukes’ B (pT2 pN0) adenocarcinoma of the rectum. He proceeded to an anterior resection, but at follow-up in January 2004 his CEA had risen to 40. A subsequent staging computed tomography scan demonstrated liver metastases with no additional visceral disease. He was commenced on oral capecitabine 2000 mg/m 2 daily on days 1 –14 every 3 weeks. After the first cycle the patient felt that his symptoms relating to digital Raynaud’s were gradually deteriorating. On examination, all distal phalanges were hyperaemic and desquamating, but there were no signs of digital infarction or palmar–plantar erythema. Although the chemotherapy dose was reduced to 1500 mg/m 2 daily for the second cycle, there was no amelioration of his symptoms. At this point his erythrocyte sedimentation rate was 12 and the autoantibody screen was negative. In view of the reported connection between exacerbations of Raynaud’s and fluoropyrimidine therapy [5], the capecitabine was discontinued. The patient promptly received vasodilator treatment with a prostaglandin infusion, which led to a moderate improvement in the pulp desquamation. Following 1 week of treatment rest the patient was commenced on raltitrexed. Although the EDTA was 63 ml/min, in view of his general frailty this was initiated at a reduced dose of 1.5 mg/m 2 intravenously every 4 weeks. After receiving four cycles the patient’s symptoms continued to improve significantly and he experienced no major toxicity relating to the alternative chemotherapy. Unfortunately, in September 2004 this gentleman’s liver metastases have progressed and he is currently receiving irinotecan with no further exacerbations in his digital Raynaud’s. This case highlights that a degree of caution should be adopted in initiating capecitabine in patients with a history of peripheral vasospasm. Although there are a variety of postulates on the pathophysiology of fluoropyrimidine-related vascular toxicity, it is still poorly understood. Most hypotheses focus on the induction of coronary vasospasm [6– 9] via activated protein kinase C [9] and direct vascular endothelial damage [10] from 5-FU or 5-FU metabolites as being the main factors responsible for its cardiotoxicity. It has also been suggested that the final step of capecitabine’s conversion to 5FU by thymidine phosphorylase (TP) in the myocardium may also contribute to cardiovascular problems [11]. There are fewer published articles on the effects of 5-FU with Raynaud’s, and these also suggest that mechanisms involving changes in endothelium, hyperviscosity and platelet activity may be responsible for the peripheral vasospasm associated with this drug [7–9]. However, there are no published reports relating to Raynaud’s disease being exacerbated by capecitabine. Since our patient’s diagnosis, this gentleman has required annual prostaglandin infusions to alleviate his symptoms. Capecitabine clearly affected the control of his disease and the symptoms subsided when the treatment was discontinued. As with coronary vasospasm, it is reasonable to assume that capecitabine induces its effects on Raynaud’s via mechanisms similar to 5-FU. Significantly, TP levels appear to be elevated in hypoxic environments [12]. Hence it is feasible that the deleterious side-effects of capecitabine witnessed in this disease could be potentiated by digital ischaemia itself. Although the improvement can mainly be attributed to the vasodilatory therapy, no recurrence was evident with raltitrexed, a thymidine synthase inhibitor with no documented cardiac side-effects.

A phase I/IIa clinical trial of CLAOP21 and CLAOP14 in patients with high-grade non-Hodgkin's lymphoma and cardiac risk factors

6708 Background: CHOP is the standard combination chemotherapy for high-grade Non-Hodgkin's-lymphoma (NHL). Pegliposomal doxorubicin in comparison to free doxorubicin has minimal cardiotoxicity. We performed a phase I/II study of a modified CHOP regimen including pegliposomal doxorubicin, termed CLAOP, in patients with high-grade NHL and cardiac risk factors. Methods: A three-weekly (CLAOP21) and a bi-weekly (CLAOP14) regimen were explored: CLAOP21 with 20mg/m2 of pegliposomal doxorubicin every 21 days, and a dose-dense CLAOP14 regimen every 14 days with escalating doses of pegliposomal doxorubicin supported by G-CSF. Results: 113 treatment cycles were administered to 22 patients. In the initial 12 patients CLAOP21/20mg/m2 was well tolerated with a degree of hematotoxicity similar to that reported with regular CHOP. The dose-dense CLAOP14/20mg/m2 was not associated with dose-limiting hematotoxicity, but three febrile episodes occurred in 27 treatment cycles. CLAOP14/25mg/m2 was associated with dose-limiting hematotoxicity and palmar plantar erythema. Grade III leucopenia and febrile infections developed in 3 of 5 patients, and PPE grade III in 2 of 5 patients, respectively. Both, the 3-weekly and the 2-weekly regimens were active with an overall response rate of 60%. Cardiotoxicity attributable to doxorubicin was not observed in any patient. Conclusions: The recommended dose of pegliposomal doxorubicin in the CLAOP regimen for Phase II/III testing is 20mg/m2. This regimen can be administered to lymphoma patients with concomitant cardiovascular disease without apparent cardiotoxicity. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Schering-Plough

Analysis of the time course and prognostic factors determining toxicity due to infused fluorouracil.

This study used a prospectively managed clinical database in order to identify 1470 patients with gastrointestinal cancers receiving protracted venous infusion (PVI) fluorouracil (5FU). It aimed to determine the time course of toxicity due to PVI 5FU and to analyse factors predicting toxicity. The initial development of stomatitis occurred more rapidly than diarrhoea or palmar plantar erythema (PPE). The percentage of patients with National Cancer Institute Common Toxicity Criteria (CTC) grade 2 or worse PPE peaked at 9% between weeks 8 and 17, whereas this peak occurred earlier for stomatitis and diarrhoea. The development of CTC grade 1 toxicity in the first 28 days after commencement of chemotherapy was classified as early grade 1 toxicity. Multivariate Cox regression analysis showed that female sex, better performance status, elevated bilirubin, early grade 1 PPE and early grade 1 diarrhoea were independent prognostic factors for the development of CTC grade 2 or worse PPE (P<0.01). Female sex, increased age, elevated alanine transaminase and urea and early grade 1 PPE were significant independent prognostic factors for the development of CTC grade 2 or worse stomatitis (P<0.01). Early CTC grade 1 diarrhoea predicted CTC grade 2 or worse diarrhoea (P<0.01). Older, female patients with good performance status and impaired liver and renal function who develop early grade 1 PPE alone or in combination with diarrhoea are at highest risk of subsequently developing grade 2 or worse PPE or stomatitis during treatment with PVI 5FU. Reduction of infused 5FU dose should be considered for these patients. Such an approach could both reduce severe toxicity owing to chemotherapy and minimise treatment delays, and should be evaluated prospectively.

High-Dose Methotrexate-Induced Bullous Variant of Acral Erythema

Waltzer and Flowers 1 have identified a chemotherapy-induced bullous variant of acral erythema that is always associated with cytarabine, given alone or in combination with other agents. We report a case of bullous acral erythema occurring after the administration of high-dose methotrexate to an adolescent patient. Report of a Case. A 13-year-old girl was treated with methotrexate for chondroblastic osteogenic sarcoma of the left humerus at a dose of 12 g/m 2 (14 g per cycle). Each cycle was given at 1-week intervals. Within 24 hours following the seventh cycle, a symmetrical, edematous, painful, red, violaceous erythema developed on the balls of the feet and the fleshy part of the toes. A slight redness was noted on the palms of the hands. Over a 72-hour period, the plantar erythema became covered with large bullae, especially on the pressure points ( Figure 1 ). Simultaneously, diffuse macular lesions, which were purpuric and necrotic

Plantar erythema nodosum: cases in two children

Plantar erythema nodosum: cases in two children

Plantar Erythema Nodosum: Cases in Two Children

Erythematous nodules localized to the plantar surfaces in children occur occasionally, and the diagnosis of these lesions may be challenging to the clinician. Among the possible causes for isolated unilateral and bilateral blanchable erythematous nodules on the plantar surfaces in children are erythema nodosum, delayedpressure urticaria, cellulitis, and inflamed epidermoid cysts.1-4Hern and Schwayder1recently reported the first documented case of erythema nodosum localized to the plantar surfaces.1We describe two additional children with isolated plantar erythema nodosum. Report of a Case Case 1. Red, painful nodules developed in a 6-year-old boy 2 weeks after an upper respiratory tract infection. No cough, sore throat, nausea, vomiting, or diarrhea was present. No medications had been administered. Findings from his physical examination revealed six tender erythematous 1-cm nodules on the distal instep of both feet (Figure 1). Otherwise, the findings were unremarkable. Histopathologic examination of lesional tissue revealed

Palmar and plantar erythema due to infusion of sympathomimetics in pregnant women

Palmar and plantar erythema due to infusion of sympathomimetics in pregnant women