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Symmetrical lividity of the palms or soles - Skin
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Symmetrical lividity of the palms or soles - Skin

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Contributors: Mari M. Batta DO, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Symmetrical lividity of the palms or soles is a common acute symmetric eruption resulting from prolonged maceration of occluded volar skin in patients with hyperhidrosis. Most patients are healthy adolescents or young adults who present with complaints of hyperhidrosis, bromhidrosis, and occasional tenderness or itching of palms or soles. A history of hyperhidrosis in conjunction with occlusive gloves or footwear is commonly elicited. There may be a family history of symmetrical lividity. Additional predisposing factors include pressure and friction from ill-fitting shoes or thin soles, poor ventilation from nylon stockings or heavy shoes and socks, and psychoneurosis. Of note, it appears that occupation is not a predisposing factor.

Clinically, bilateral, sharply marginated, soggy, white hyperkeratotic plaques with erythematous to bluish-red (livid) borders are seen. Although the name implies a more bluish hue, the plaques are more commonly erythematous. Sites of involvement include pressure areas of the soles (balls of the feet and heels), followed by the palms, and less commonly the dorsal toes and fingers. Typically, lesions are bilateral; however, unilateral involvement and involvement of both hands and feet have been described.

This condition has been subdivided into two forms:
  • Transient symmetrical lividity – induced by various forms of stress along with the use of occlusive footwear; can be successfully treated with drying agents
  • Persistent (chronic) symmetrical lividity – possibly familial; unresponsive to drying agents but with partial response to tretinoin cream
The natural course is unpredictable; while some cases are self-limited and resolve within days, others may have a chronic course of varying intensity. However, with treatment, both the eruption and hyperhidrosis can be controlled.

Codes

ICD10CM:
L98.8 – Other specified disorders of the skin and subcutaneous tissue

SNOMEDCT:
238760005 – Symmetrical lividities of soles

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Last Updated: 01/23/2015
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Symmetrical lividity of the palms or soles - Skin
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Symmetrical lividity of the palms or soles : Bilateral, Erythema, Macerated skin, Palms and soles, Hyperhidrosis
Clinical image of Symmetrical lividity of the palms or soles
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