Polycythemia Vera and Brown Vascular Lesions on Hands
Polycythemia vera does not cause brown vascular lesions on the hands. The characteristic vascular manifestations of PV are erythromelalgia (painful red, warm hands/feet) and plethora (ruddy discoloration), not brown lesions.
Actual Vascular Manifestations of Polycythemia Vera
Erythromelalgia
- Erythromelalgia presents as painful, burning sensations of the feet or hands associated with erythema (redness) and warmth—not brown discoloration 1.
- This microvascular disturbance occurs in approximately 3% of PV patients and results from platelet-mediated endothelial cell injury causing inflammation and transient thrombotic occlusion by platelet aggregates 1.
- The condition responds promptly (within hours) to low-dose aspirin (81 mg/day) in most patients 1.
- If aspirin fails, normalization of platelet count with cytoreductive therapy may be necessary 1.
Plethora
- Plethora manifests as a ruddy or reddish-purple discoloration of the face and skin, particularly in sun-exposed areas—again, not brown lesions 2.
- This results from increased red blood cell mass and engorged superficial blood vessels 2.
- Patients exhibit visibly distended superficial veins and conjunctival injection (redness of the eyes) 2.
- Plethoric appearance improves with therapeutic phlebotomy targeting hematocrit below 45% 2.
Other Microvascular Disturbances in PV
The spectrum of microvascular complications includes 1:
- Headache and light-headedness
- Transient neurologic or ocular disturbances
- Tinnitus
- Atypical chest discomfort
- Paresthesias
These manifestations represent transient inflammation-based occlusive phenomena from interaction between clonal platelets and arteriolar endothelium 1.
Clinical Pitfall
Brown vascular lesions on the hands should prompt evaluation for alternative diagnoses, such as:
- Venous stasis dermatitis with hemosiderin deposition
- Actinic lentigines (sun damage)
- Post-inflammatory hyperpigmentation
- Other dermatologic or vascular conditions unrelated to PV
The vascular complications of PV are characterized by acute redness, warmth, and pain (erythromelalgia) or chronic ruddy discoloration (plethora)—not brown pigmentation 1, 2, 3.