Green palmar discoloration in a patient with primary sclerosis cholangitis: eccrine chromhidrosis or pompholyx?
Bochra Bouchabou1,2 | Fatma Ben Farhat1,2 | Rym Ennaifer 1,2 | Abderrahmen Ennakhli1,2 | Houda Ben Nejma1,2
1Department of Gastroenterology, Mongi Slim Hospital, Tunis, Tunisia
2Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Correspondence
Fatma Ben Farhat, Department of Gastroenterology, Mongi Slim Hospital, Tunis, Tunisia. Email Fatmabf8@gmail.com
Abstract:
Background: Chromhidrosis is defined by the secretion of colored sweat. As sweat can be produced by either eccrine or apocrine glands, chromohidrosis can be divided into subtypes and can have multiple locations through the body. In the other hand, pompholyx is a type of eczema characterized by the development of palmar and plantar vesicles.
Case report: we report the case of a 33-year-old woman with decompensated cirrhosis complicating Primary sclerosis cholangitis (PSC) suffering from abnormal bilateral pigmentation on palms, which lasted two weeks. On clinical examination, green desquamative papules were observed on the two palms (Fig.1) and levels of total (34.4 mg/dl) and direct (17 mg/dl) bilirubin were elevated. No specimen for histological research was done because lesions were already desquamative. Bacterial samples were done without any sign of fungic or bacterial infection.Conclusion: The case that we report can be eccrine chromhidrosis resembling the clinical features of pompholyx with explanation of probable pathomechanism. The green color is attributable to the switch from brown-colored bilirubin to green-colored biliverdin by oxidative processes.