As Janeway lesions are small spots or lumps on the skin, usually only a few millimeters in size. They are painless and usually appear on the extremities. Some sources list Theodore Caldwell Janeway as its discoverer, but they were actually discovered first by his father, the American clinician and pathologist Edward G. Janeway (1841-1911).
What is Janeway Lesions?
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Janeway lesions are erythematous (reddened) or hemorrhagic (bleeding) skin changes that can be both flat and raised. They are painless, usually between 1 and 5 millimeters in size, of a reddish-brown color and can be found on the palms of the hands, fingers, soles of the feet and toes. As a rule, they are caused by a microembolism, i.e. the closure of the smallest blood vessels by a blood clot.
Pathologically, they are described as microabscesses of the dermis, i.e. the dermis.Foci of inflammation penetrate the cell tissue and cause necrosis, which means that the cell tissue breaks down. The epidermis, i.e. the upper layer of the skin, is not affected by the Janeway lesions. The lesions usually have their origin in a septic embolism, which bacteria deposit in the blood vessels and thus cause the microabscesses.
causes
The Janeway lesion is an indication of bacterial endocarditis, i.e. inflammation of the inner lining of the heart (endocardium). Mostly it is caused by staphylococci or streptococci. The possibilities of infection are diverse.
Wounds, including those caused by invasive medical procedures, can be a cause. However, bacteria can also get into the blood through injuries to the oral cavity or feverish diseases such as urinary tract infections, pneumonia or tonsillitis, bronchitis and thus form the basis for endocarditis. In people with healthy hearts, these bacteria are usually caught in good time by the phagocytes.
However, patients with heart disease or heart valve replacement are at increased risk of developing inflammation of the lining of the heart. If left untreated, endocarditis is usually fatal, but it can be treated well with antibiotics.
Symptoms, ailments & signs
Janeway lesions can cause very different symptoms and discomforts, depending on where they occur and what the underlying cause is. Typically, the skin changes appear on the hands and feet. There, reddish-brown spots or lumps form, which can reach a size of one to five millimeters and which are accompanied by increasing itching.
Pain usually does not occur, but ulcers can form, which are very painful. Infections can also develop in the ulcer area, which increases the symptoms. The symptoms of Janeway lesions usually appear suddenly. The spots often develop overnight and enlarge in the coming days.
The typical itching usually occurs between the third and fifth day, while the formation of ulcers takes place after one to two weeks. If the Janeway lesions are caused by a heart defect, they can lead to cardiac death if left untreated. With early treatment, the small spots will recede after a few days to weeks.
If ulcers have already formed, scars may remain. In severe cases, permanent sensory disorders or even symptoms of paralysis appear in the affected area, which also represent a great psychological burden for the person concerned.
Diagnosis & course of disease
Since the skin changes themselves usually do not cause any symptoms, they are often discovered as secondary findings. This means that the patient is receiving medical treatment for another illness. The Janeway lesions are usually recognized as such by the doctor. However, a biopsy of the affected tissue is very often necessary to make a reliable diagnosis.
Treatment of the Janeway lesions themselves is not possible. They go away after treating the underlying condition, endocarditis. However, ointments can be prescribed for relief. Treatment of the lesions is therefore always accompanied by treatment of the underlying disease, endocarditis. As this is a life-threatening condition, treatment must be given in the hospital.
There the patient is given antibiotics as intravenous infusions. The choice of the appropriate antibiotic depends on the type of pathogen. If the patient is in a life-threatening condition, the doctor does not have time to wait for the result of the blood culture. Then antibiotics must be started immediately.
In less acute cases, the result of the blood test can be awaited so that the antibiotic can be better matched to the pathogen. Treatment usually lasts four to six weeks and aims to completely remove the bacteria from the affected tissue. If this therapy does not bring the desired success, cardiac surgery must be carried out very promptly.
This improves the patient's chances of survival and also prevents an embolism. In order to avoid such drastic measures, antibiotic therapy is started as soon as endocarditis is suspected. It is not always possible to prevent an initial illness, but the consequential damage can be well controlled and contained.
Complications
The Janeway lesion, in most cases, results in spots on the skin. These spots are red and in most cases relatively small. However, they can lead to aesthetic complaints, so that those affected do not feel comfortable with the stains and this leads to inferiority complexes or a reduced self-esteem. However, these spots are painless and do not cause any further complaints.
However, ulcers can also develop on the spots themselves. It is not uncommon for patients to withdraw from social life due to the Janeway lesion and therefore also suffer from psychological complaints or depression. Usually the Janeway lesion occurs as a result of some other condition that definitely needs treatment.
If heart defects are the cause of the Janeway lesion, they must be treated by a doctor. Without treatment it can lead to cardiac death. In some cases, however, a heart transplant is necessary to limit the symptoms. This can lead to a reduction in life expectancy. In most cases it cannot be generally predicted whether the treatment will lead to a positive course of the disease.
When should you go to the doctor?
A doctor's visit should take place as soon as the visual changes appear for the first time. The abnormalities in the skin's appearance are a sign and warning of an underlying disease. It is advisable to have these medically examined and diagnosed so that no further diseases and thus a deterioration in health occur. In most cases, the Janeway lesions resolve on their own as soon as the underlying disease is treated and cured.
If this does not happen in the desired way despite all efforts, a doctor should be visited if the red spots on the skin are bothersome or unpleasant. If the visual flaw causes emotional or emotional changes, a doctor should be consulted and advice should be sought. Consult a doctor if you feel generally unwell or have feelings of shame or disgust.
If there are behavioral problems, a change in personality or social withdrawal, a check-up visit to a doctor or therapist is recommended. If the lesions increase in size and number, a doctor should be examined. If there is swelling, small lumps or ulcers on the skin, this development is considered unusual. A medical check-up should be initiated so that serious illnesses or blunt injuries can be ruled out.
Treatment & Therapy
Basically, people with heart defects are at higher risk of developing endocarditis. According to the guidelines of the American Heart Association (AHA) from 2007, to which the German Society for Cardiology (DGK) also joined, prophylactic measures are particularly necessary for patients with heart valve replacement, after surviving endocarditis, with congenital heart defects and surviving heart transplants.
In this risk group, antibiotic treatment is urgently required before any operation, including dental interventions. The patients are issued a cardiac card that must be carried with them for every operation and examination.
In addition, they should see a doctor immediately at the slightest sign of an infectious disease, so that antibiotic therapy can be started as soon as possible. If there is an allergy to penicillin, oral administration of lincosamides can be used.
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The prognosis for the Janeway lesion is tied to the causal disease. If there is inflammation, medical care should be sought, otherwise the symptoms will increase. The itching can cause open wounds to form on the body, which in severe cases can lead to sepsis. There is thus a potential risk to the life of the person concerned.
If there is a congenital or acquired heart defect, the risk of the patient's premature death is increased. If left untreated, cardiac death occurs in many cases. If cardiac surgery is necessary, the associated complications and side effects must be taken into account when making a prognosis.
With an early and comprehensive diagnosis and subsequent treatment, the skin changes can normally be treated well. Within a few days to a few weeks, a regression of the changes in the complexion and subsequent freedom from symptoms can be expected. Some patients may experience scarring on the skin during the healing process.
Consequences such as disorders of sensitivity or an increase in psychological stress due to the optical changes can occur. In addition, there is a possibility of developing the Janeway lesion again in the course of life. The prognosis remains unchanged with a repeated outbreak of the unpleasant skin changes.
prevention
The above-mentioned risk groups should definitely attend the regular preventive examinations and go to the doctor immediately if there is the slightest sign of infection. You should also always have your heart card with you. A healthy lifestyle with a balanced diet, adequate sleep and regular physical activity also helps to strengthen the immune system and thus avoid diseases such as endocarditis and the associated Janeway lesion.
Aftercare
In most cases, direct follow-up care measures for the Janeway lesion are very limited, so that those affected with this disease are primarily dependent on a quick diagnosis and subsequent treatment. This is the only way to avoid further deterioration, which can possibly lead to complications.
The Janeway lesion cannot heal on its own, so the patient should see a doctor at the first symptoms and signs of the disease. The earlier the doctor is contacted, the better the further course of this disease is usually. The disease itself is treated by taking medication, although a complete cure is usually not possible.
Those affected are dependent on taking the medication regularly and on the correct dosage in order to permanently alleviate the symptoms. During surgical interventions, the attending physician should be informed about the Janeway lesion so that there are no complications during the procedure. This disease may also reduce the life expectancy of those affected.
You can do that yourself
The Janeway lesion must first be diagnosed and treated by a doctor. Those affected can do a few things themselves to alleviate the symptoms and avoid a severe course.
First of all, a heart card must be applied for, which should be carried with you for every examination and medical treatment. The underlying heart disease should be treated supportively according to the instructions of a specialist. Depending on the type of ailment, measures to strengthen the heart, other organs and the immune system are recommended. Exercise is just as recommended to a certain extent as a stress-free lifestyle. In addition, the diet must be changed in order to avoid further stress on the heart. If there are signs of an infectious disease, a doctor must be consulted immediately.
The Janeway lesion itself cannot be treated with home remedies and self-measures. After medical treatment, increased hygiene measures are indicated. The affected skin areas must be cared for with a medicinal preparation and should not be exposed to any further irritation. Finally, the person concerned should take it easy for a few days and arrange additional check-ups with the responsible doctor.
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