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Tripe palms

Authors: Kelvin Truong, Dermatology Research Fellow; Raquel Ruiz Araujo, Specialist Dermatologist, Westmead Hospital, New South Wales, Australia. Copy edited by Gus Mitchell. February 2022

What are tripe palms?

Tripe palms are a very rare skin condition affecting the palms of hands and soles of feet; it is characterised by thickened skin resembling the stomach lining of some animals (tripe).

Tripe palms, also known as acanthosis palmaris or acquired pachydermatoglyphia, are frequently associated with internal malignancy . Tripe palms are a paraneoplastic dermatosis ; a group of skin conditions that are caused by cancer and share the same underlying genetic basis. It often coexists with acanthosis nigricans .

Tripe palms associated with acanthosis nigricans

Acanthosis nigricans

Who gets tripe palms?

There are approximately 100 cases of tripe palms reported in medical literature. It is more common in males than in females. 

Approximately 90% of cases of tripe palms are associated with internal malignancy. Skin changes may precede the diagnosis of, or develop during, malignancy. 

Tripe palms has also been associated with non-cancerous conditions such as:

• Bullous pemphigoid
• Exfoliative dermatitis .

What causes tripe palms?

The exact mechanism through which tripe palms develops is unknown. It is thought that the cancer cells secrete growth factors , such as epidermal growth factor -α and transforming growth factor-α, causing growth of skin cells (or more specifically keratinocytes ) and hence the appearance of tripe palms.

Cancers that have frequently been associated with tripe palms include:

• Gastric cancer
• Lung cancer.

And less frequently:

• Breast cancer
• Genitourinary tract cancers.

What are the clinical features of tripe palms?

Typically, patients with tripe palms present with thickened skin on the palms of their hands. This thickening can accentuate dermatoglyphic change which appears as a velvety pattern. The thickening often gives a yellow hue to the skin. These features are akin to the lining of the stomach, hence the skin condition being termed tripe palms. The soles of feet can also be affected. 

Tripe palms usually coexists with malignant acanthosis nigricans in approximately 7 of 10 cases. Acanthosis nigricans is a skin condition that describes the darkening and velvety appearance of body folds, such as the neck, armpits, and groin.

Tripe palms can be found alongside: 

• Clubbing of the fingernails (1 in 5 persons)
• Itchiness of the skin (1 in 4 persons)
• Cutaneous papillomatosis
• Multiple fast growing seborrhoeic keratosis ( sign of Leser-Trélat ).

How are tripe palms diagnosed?

Tripe palms are diagnosed clinically. A biopsy of the skin is not helpful in confirming the diagnosis, as the histologic findings are non-specific.

What is the differential diagnosis for tripe palms?

The clinical appearance of tripe palms can be like:

• Acrokeratosis paraneoplastica
• Hypertrophic pulmonary osteoarthropathy
• Pachydermoperiostosis
• Palmoplantar keratoderma
• Thyroid acropachy .

What is the treatment for tripe palms?

Patients presenting with tripe palms and without a history of cancer need to be worked up for malignancy. This includes:

• Thorough medical history
• Complete physical examination
• Further investigations based on the findings.

The treatment of tripe palms is challenging. As tripe palms are very rare, there is limited high quality evidence to guide its management. Management with oral retinoids have helped. 

What is the outcome for tripe palms?

Approximately 3 out of 10 cases of tripe palms resolve when the underlying cancer is managed. However, tripe palms may persist despite remission of the underlying cancer.

Bibliography

• Barman B, Devi LP, Thakur BK, Raphael V. Tripe Palms and Acanthosis Nigricans: A Clue for Diagnosis of Advanced Pancreatic Adenocarcinoma. Indian Dermatol Online J. 2019;10(4):453–5. 10.4103/idoj.IDOJ_427_18. Journal
• Cohen PR, Grossman ME, Almeida L, Kurzrock R. Tripe palms and malignancy. Journal of Clinical Oncology. 1989;7(5):669–78. 10.1200/jco.1989.7.5.669. Journal
• Danesh MJ, Saylor DK, Leard LE, North JP, Fox LP. Acquired acanthosis nigricans with tripe palms in a patient with interstitial lung disease. JAAD Case Reports. 2016;2(1):59–62. 10.1016/j.jdcr.2015.11.008. PubMed Central
• Pipkin CA, Lio PA. Cutaneous manifestations of internal malignancies: an overview. Dermatol Clin. 2008;26(1):1–15, vii. 10.1016/j.det.2007.08.002. Journal
• Requena L, Aguilar A, Renedo G, et al. Tripe palms: a cutaneous marker of internal malignancy. J Dermatol. 1995;22(7):492–5. Journal
• Silva JA, Mesquita Kde C, Igreja AC, et al. Paraneoplastic cutaneous manifestations: concepts and updates. An Bras Dermatol. 2013;88(1):9–22. 10.1590/s0365-05962013000100001. Journal
• Thiers BH, Sahn RE, Callen JP. Cutaneous manifestations of internal malignancy. CA Cancer J Clin. 2009;59(2):73–98. doi:10.3322/caac.20005. Journal
• Cutaneous markers of internal malignancy
• Hypertrophic osteoarthropathy and digital clubbing

Other websites

• Dermatologic manifestations of paraneoplastic syndromes — Medscape

Books about skin diseases

• Books about the skin
• Dermatology Made Easy  - second edition

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Tripe Palms

December 4, 2014

A patient’s hands may reveal much about them. Fingers, nails and palms can all tell their own stories of habits, occupations or disease.

The right hand of a 71-year-old female is shown below.

Deep tar staining of the thumb and pulps of the index and second finger are visible – a consequence of many years manipulating cigarettes in that hand.

But note too the exaggerated dermatoglyphics, the ridged, velvety appearance of the skin in places, particularly on the hypothenar eminence, shown close up in our second image below.

Our patient, when asked, had noticed the appearance slowly developing over the past year. It wasn’t itchy or painful and she was in hospital for another reason entirely.

She had coughed up some blood.

This is a rare condition, known as acquired palmoplantar keratoderma. But some clinicians, particularly those from countries where offal is still eaten, compare the appearance to that of an animal’s intestine, after boiling of course!

So, “tripe palms” is the much more memorable name given to this rather odd appearance.

In 90% of cases it is associated with underlying neoplasia – as was the case for our patient, whose hemoptysis was caused by a primary pulmonary adenocarcinoma.

A tumor of the lungs, revealed in the hands.

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Sunday, March 1, 2020

A hand pieced trip around the world quilt.

18 comments:

You always have such cheerful looking quilts. Congratulations on hand piecing your beautiful TATW!

Wow! It’s amazing that you called this slow. To hand piece this in less than 3 months is not what I’d call slow. I love hand piecing because it’s relaxing but I don’t think you were relaxing at all. It’s a beautiful quilt.

This the quilt pattern my Great Grandmother tried to reach me to hand piece on. I was maybe 10. Thanks for the memory. Beautiful quilt.

Very nice!!

"easily distracted"? ha! that is the story of my life lately. This quilt is absolutely beautiful Rita. I love it. I hope you and the family are doing well. My sewing is very slow as I only sew early in the morning or late at night. I am running on "in a hurry - on stand by" is the only way I can explain it. Sewing relaxes me. Keep sewing. YOu are always so inspiring

Absolutely beautiful!

So beautiful! Great work! Thank you for sharing and inspiring!

Oh my, this is fabulous. I couldn't even think of hand piecing a trip quilt. x

Striking colour composition. Beautiful quilt!

Amazing job! I’ve noticed hand piecing is making a little bit of a comeback. You are inspiring quilters to return to enjoying the process and embracing the process!

It's absolutely gorgeous.

Great to hear from you! Your color choices are beautiful, as always, and your stitches look precise and even to me!

Simply beautiful (as always); thanks for sharing!

This is amazing! I always appreciate you sharing your process.

I love..love...LOVE this quilt!!!!!

You are absolutely amazing! And such an inspiration!

You are crazy talented!! Beautiful.

Congratulations on 'slowing down to the speed of life' and for your stunningly beautiful quilt. Thanks for sharing. In the absence of my regular weekly quilting class (shielding/lockdown)I have started a City & Guilds on line patchwork & quilting course and am learning to sew BLOCKS rather than my favoured improv modern quilting style. Slow and challenging but very pleasurable.

Thank you for stopping by and leaving a comment! I really appreciate it. Comments are published after review. Feel free to ask questions and I will answer either here or by email, as is appropriate.

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