From the Guidelines
To differentiate between Janeway lesions and pustulosis, focus on their distinct clinical characteristics, with Janeway lesions being non-tender, painless, flat hemorrhagic macules and pustulosis presenting as tender, raised pustules. When evaluating these conditions, it's crucial to consider the clinical presentation, as described in guidelines for managing psoriasis and psoriatic arthritis 1. Janeway lesions are characterized by their appearance on the palms and soles, lack of tenderness, and association with systemic infection and heart valve issues, making them pathognomonic for infective endocarditis. In contrast, pustulosis, such as pustular psoriasis, may present with generalized or localized pustules on an erythematous background, accompanied by fever and toxicity in severe cases, as noted in the guidelines 1. Key differences include:
- Location and appearance: Janeway lesions are typically found on the palms and soles and are flat, while pustulosis can be generalized or localized and presents as raised pustules.
- Tenderness: Janeway lesions are non-tender, whereas pustulosis is often tender.
- Association: Janeway lesions are associated with infective endocarditis, and pustulosis is linked to inflammatory conditions like psoriasis or may be drug-induced. Given these distinctions, if Janeway lesions are suspected, immediate further evaluation for endocarditis is necessary, whereas pustulosis typically requires a dermatological assessment and possibly a skin biopsy for a definitive diagnosis.
From the Research
Differences between Janeway Lesions and Pustolosis
To differentiate between Janeway lesions and pustolosis, consider the following characteristics:
- Etiology: Janeway lesions are associated with infective endocarditis, typically caused by bacteria such as Staphylococcus aureus 2, 3, 4, whereas pustolosis, specifically palmoplantar pustulosis (PPP), is a chronic inflammatory skin disease belonging to the localized form of pustular psoriasis 5.
- Clinical Presentation: Janeway lesions are characterized by septic-embolic manifestations, including cutaneous lesions that may show minimal inflammatory reaction 2, while PPP is marked by sterile pustule formation in palms and soles with a recurrent disease course 5.
- Histological Features: Janeway lesions may exhibit subtle histological features, including dilated blood vessels, extravasated erythrocytes, and deep dermal vessels occluded by fibrin thrombi 3, whereas the histologic findings in PPP are not explicitly described in the provided studies.
- Treatment: The management of Janeway lesions involves addressing the underlying infective endocarditis, whereas PPP treatment options include topical corticosteroids, oral acitretin, immunosuppressants, phototherapy, and targeted therapies like secukinumab and ustekinumab 5.
Diagnostic Considerations
When diagnosing Janeway lesions, it is essential to consider the clinical-pathological correlation and the subtle histological features 3, as well as the patient's overall condition and laboratory findings, such as blood cultures 3. In contrast, diagnosing PPP involves identifying the characteristic sterile pustules in palms and soles and considering the disease's recurrent nature 5.