Editing Janeway lesion

{{Short description|Small red lesions of the hands and feet}}
{{Infobox medical condition (new)
| name            = Janeway lesion
| synonyms        =
| image           = Janeway lesion.JPG
| caption         =
| pronounce       =
| field           = *[[Cardiology]]
* [[Dermatology]]
| symptoms        = Painless red flat papules on palms and soles<ref name=Parashar2022/>
| complications   =
| onset           = Sudden
| duration        = Days to weeks<ref name=Parashar2022/>
| types           =
| causes          = [[Infective endocarditis]]<ref name=Parashar2022/>
| risks           =
| diagnosis       = Appearance<ref name=Parashar2022/>
| differential    = [[Osler's nodes]]<ref name=Parashar2022/>
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}
'''Janeway lesions''' are rare, non-[[Tenderness (medicine)|tender]], small [[erythematous]] or [[haemorrhagic]] [[macule|macular]], [[papule|papular]] or [[Nodule (medicine)|nodular]] lesions on the palms or [[Sole (foot)|soles]] only a few millimeters in diameter that are associated with [[infective endocarditis]] and often indistinguishable from [[Osler's nodes]].<ref name=Parashar2022>{{cite journal |last1=Parashar |first1=Krishan |last2=Daveluy |first2=Steven |title=Osler Node and Janeway Lesions |journal=StatPearls |date=2022 |pmid=32491553 |url=https://pubmed.ncbi.nlm.nih.gov/32491553/ |publisher=StatPearls Publishing  }}</ref>

==Definition==
Janeway lesions are painless, frequently haemorrhagic lesions seen most commonly on the palms and soles, particularly on the base of the thumb and little finger, and seen in infective endocarditis.<ref name=DermnetNZ>{{Cite web|url=https://www.dermnetnz.org/topics/osler-nodes-and-janeway-lesions/|title=Osler nodes and Janeway lesions {{!}} DermNet NZ|website=www.dermnetnz.org|access-date=2 October 2019}}</ref>

==Differential==
[[Osler's node]]s and Janeway lesions are similar and point to the same diagnostic conclusion.<ref name=Parashar2022/> The most significant difference between the two is that Osler's nodes present with tenderness, while Janeway lesions do not.<ref name=Parashar2022/> Osler's nodes are thought to be due to immunologic phenomenon where deposition of immune complexes provoke inflammatory response, leading to swelling, redness and pain. On the contrary, Janeway lesions are thought to be due to embolic phenomenon in cutaneous blood vessels of palms and soles which does not cause pain or least pain.<ref>{{cite web |url=https://www.youtube.com/watch?v=0egTuNrAow4| website=[[YouTube]] | title=Why Osler's Nodes are Painful while Janeway Lesions are Painless? }}</ref><ref>{{Cite journal |last1=Misin |first1=Andrea |last2=Bella |first2=Stefano Di |last3=Priolo |first3=Luigi |last4=Luzzati |first4=Roberto |date=2017 |title=Image of the month: 'Diagnostic hands': Janeway lesions |journal=Clinical Medicine |language=en |volume=17 |issue=4 |pages=373–374 |doi=10.7861/clinmedicine.17-4-373 |issn=1470-2118 |pmc=6297653 |pmid=28765422}}</ref>

==Pathophysiology==
Pathologically, the lesion is described to be a [[abscess|microabscess]] of the [[dermis]] with marked [[necrosis]] and inflammatory infiltrate not involving the [[epidermis (skin)|epidermis]].<ref name = "Farrior">{{cite journal | last = Farrior | first = J.B. |author2=Silverman M.E. | title = A consideration of the differences between a Janeway's lesion and an Osler's node in infectious endocarditis |journal = Chest | volume = 70 | issue = 2 | pages = 239–243 | year = 1976 | pmid = 947688 | doi = 10.1378/chest.70.2.239}}</ref>

They are caused by septic emboli which deposit bacteria, forming microabscesses.<ref name="Mandell">Mandell, Douglas, ''Bennett's Principles and Practice of Infectious Diseases'', 7th ed., [[Churchill Livingstone]] (2009).</ref> Organisms may be cultured from the lesions.<ref name=Patterson2016>{{Cite book|chapter-url=https://books.google.com/books?id=Y-LTBQAAQBAJ&q=janeway|title=Weedon's Skin Pathology|last=Patterson|first=James W.|date=2016|publisher=Churchill Livingston|isbn=978-0-7020-5183-8|edition=4th|pages=239–240|language=en|chapter=8. The Vasculopathic Reaction Pattern}}</ref>

==Diagnosis==
Janeway lesions present as red, painless macules and papules on the palms and soles.<ref name=DermnetNZ/>

They are not common and are frequently indistinguishable from [[Osler's nodes]]. Rarely, they have been reported in cases of [[systemic lupus erythematosis]] (SLE), [[gonococcemia]] (disseminated gonorrhoea), [[haemolytic anaemia]] and [[typhoid fever]].<ref name=DermnetNZ/>

They may last days to weeks before completely resolving.<ref name=Parashar2022/>

==History==
Janeway lesions are named after [[Edward Gamaliel Janeway|Edward Janeway]] (1841–1911), a prominent American physician, pathologist and contemporary of Sir [[William Osler]], who initially described "peculiar skin lesions" in some people with endocarditis, in a paper published in 1899. The term was first used by [[internal medicine|internist]] and pathologist [[Emanuel Libman]], who reported the lesions in his paper of 1906 and explained his reasoning for using the term "Janeway lesions" in a footnote in 1923. Osler never mentioned Janeway lesions. The inclusion into Osler's 1925 textbook came six years after Osler died.<ref name=prutkin>{{cite journal|title=Edward G. Janeway, Clinician and Pathologist|author=Jordan Prutkin |author2=[[W. Bruce Fye]] |journal=[[Clinical Cardiology]]|volume=29|issue = 8|pages=376–377|year=2006|doi=10.1002/clc.4960290815|pmid=16933584|pmc=6654287}}</ref>

==See also==
* [[Roth's spot]]s

==References==
{{reflist}}

== External links ==
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|  ICD10          = A41.8 ([[ILDS]] A41.820)
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{{Cardiovascular system symptoms and signs}}

[[Category:Symptoms and signs: Cardiac]]
[[Category:Cutaneous conditions]]