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Green Sweating Spots on Hands and Feet: Unusual Expression of Hyperbilirubinemia

Alessandro Di Stefani, MD; Luca Bianchi, MD; Augusto Orlandi, MD; and Sergio Chimenti, MD
[+] Article, Author, and Disclosure Information

From Tor Vergata University, Rome, Italy.

Potential Financial Conflicts of Interest: None disclosed.

Ann Intern Med. 2006;145(9):710-711. doi:10.7326/0003-4819-145-9-200611070-00024
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Green sweating spots as sign of cutaneous bilirubin excretion.

A. Clinical image of several deep-green macules coalescing into diffuse patches that are mainly located on the volar and lateral side of the fingers and on the palms. The skin was hyperkeratotic, and in some exfoliated areas, a normal-colored underlying skin was exposed. B. Dermoscopic image showing a linear distribution of the green pigment, mainly arranged at the level of the dermatoglyphic ridges with a partial sparing of the furrows (DermLite Foto, 3Gen, Dana Point, California; original magnification, ×10). C. Microscopic examination of palm skin biopsy specimen reveals an hyperkeratotic scale containing amorphous substance within the stratum corneum and in dilated adnexal pores (hematoxylin–eosin stain; original magnification, ×250). D. Microscopic examination of palm skin biopsy specimen shows a selective intense yellowish-green hue, suggestive of bilirubin deposition (Hall staining method; original magnification, ×250).

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