Tripe Palms

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.

palm1

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.

palm2

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.