Green palmoplantar vesicular eruption in a patient with hyperbilirubinemia

INTRODUCTION Green pigmentation on the palms and soles in patients with hyperbilirubinemia is a rare entity. Eccrine chromhidrosis is an unusual form of green acral pigmentation characterized by the secretion of colored sweat from the eccrine glands. Rarely, eccrine chromhidrosis can mimic an eczematous process leading to misdiagnosis. We report a case of a patient with hyperbilirubinemia who presented with multiple deeply seated, greenish-black vesicles on the hands and feet, mainly of the palmoplantar surfaces, and pityriasis rosea on the trunk. Although the clinical presentation of the palms and soles appeared to be consistent with pompholyx, the color of the vesicles suggested other underlying pathophysiology. We suspect our patient had a variant of eccrine chromhidrosis secondary to hyperbilirubinemia presenting as greenish-black pompholyx. Here we describe the clinicopathologic features and potential pathomechanism of this unusual cutaneous presentation.