Janeway lesions are small patches or nodules on the skin, usually only a few millimeters in size. They are painless and usually occur on the extremities. Some sources list Theodore Caldwell Janeway as their discoverer, but they were actually first discovered by his father, American clinician and pathologist Edward G. Janeway (1841 – 1911).
What are Janeway lesions?
Janeway lesions are erythematous (reddened) or hemorrhagic (leading to bleeding) skin lesions that can be flat or raised. They are painless, usually between 1 and 5 millimeters in size, reddish-brown in color, and are found on the palms, fingers, soles, and toes. They usually result from microembolism, the occlusion of tiny blood vessels by a blood clot. Pathologically, they are described as microabscesses of the dermis, i.e. the dermis. Inflammatory lesions invade the cellular tissue and cause necrosis, which means that the cellular tissue disintegrates. The epidermis, or upper layer of the skin, is not affected by Janeway lesions. The lesions usually originate from septic emboli, which deposit bacteria in the blood vessels, causing the microabscesses.
Causes
Janeway lesion is indicative of bacterial endocarditis, which is inflammation of the inner lining of the heart (endocardium). It is usually caused by staphylococci or streptococci. The possibilities of infection are manifold. Wounds, including those caused by invasive medical procedures, can be a cause. However, bacteria can also enter the blood through injuries to the oral cavity or febrile illnesses, 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 intercepted in time by the scavenger cells. However, patients with heart disease or heart valve replacements are at increased risk of developing inflammation of the inner lining of the heart. If left untreated, endocarditis is usually fatal, but it can be treated well with the administration of antibiotics.
Symptoms, complaints, and signs
Janeway lesions can cause quite different symptoms and symptoms, depending on where they occur and the underlying cause. Typically, the skin lesions develop on the hands and feet. Reddish-brown spots or nodules form there, reaching a size of one to five millimeters and accompanied by increasing itching. Pain usually does not occur, although ulcers can form that are very painful. Infections may also occur in the area of the ulcers, leading to an increase in symptoms. The signs of Janeway lesions usually appear quite suddenly. The spots often develop overnight and increase in size over the next few 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 Janeway lesions are based on a heart defect, they can lead to cardiac death if left untreated. With early treatment, the small patches resolve after a few days to weeks. If ulcers have already formed, scars may remain. In severe cases, permanent sensory disturbances or even paralysis appear in the affected area, which also represent a great psychological burden for the affected person.
Diagnosis and course of the disease
Since the skin changes themselves usually do not cause any symptoms, they are often discovered incidentally. This means that the patient is undergoing medical treatment for another condition. Usually, Janeway lesions are recognized as such by the physician. However, a biopsy of the affected tissue is very often necessary to make a definite diagnosis. Treatment of the Janeway lesions themselves is not possible. They disappear again after the underlying disease, i.e. endocarditis, has been treated. However, ointments can be prescribed for relief. Thus, treatment of the lesions is always accompanied by treatment of the causative disease, endocarditis. Since this is a life-threatening disease, treatment must be done in the hospital. There, antibiotics are administered to the patient 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 physician has no time to wait for the blood culture result. Then the antibiotic administration must be started immediately. In less acute cases, the result of the blood test can be waited for, so that the antibiotic can be even better matched to the pathogen. The duration of treatment usually extends over 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 performed very promptly. This improves the patient’s chances of survival and also prevents embolism. To avoid such drastic measures, antibiotic therapy is therefore started as soon as endocarditis is suspected. It is not always possible to prevent initial disease in this way, but subsequent damage can be well controlled and contained as a result.
Complications
In most cases, the Janeway lesion results in patches on the skin. These spots are red and, in most cases, only relatively small. However, they can lead to aesthetic discomfort, causing the affected person to feel uncomfortable with the spots and resulting in inferiority complexes or lowered self-esteem. However, these spots are painless and do not lead to further discomfort. However, ulcers can form on the spots themselves. It is not uncommon for patients to withdraw from social life due to the Janeway lesion, and therefore suffer from psychological discomfort or depression. As a rule, the Janeway lesion occurs as a consequence of another disease, which must be treated in any case. If heart defects are the cause of Janeway lesion, they must be treated by a doctor. Without treatment, cardiac death may result. However, in some cases, heart transplantation is necessary to limit the symptoms. This may result in a reduction in life expectancy. In most cases, it cannot be generally predicted whether treatment will result in a favorable course of the disease.
When should you see a doctor?
A visit to the doctor should take place as soon as the optical changes appear for the first time. The abnormalities of the skin appearance are a sign and warning signs of an underlying disease present. It is advisable to have them medically examined and diagnosed, so that no further diseases and thus a deterioration of health develop. In most cases, Janeway lesions resolve on their own as soon as the underlying disease is treated and cured. If this does not occur in the desired way despite all efforts, a visit to the doctor should be made if the red spots on the skin are perceived as disturbing or unpleasant. If the visual blemish causes emotional or mental changes, a doctor should be consulted and advice sought. In case of a general feeling of discomfort as well as feelings of shame or disgust, a doctor should be consulted. If there are behavioral abnormalities, a change in personality, or social withdrawal, a follow-up visit with a physician or therapist is recommended. If the lesions increase in size and number, clarification by a physician is necessary. If swellings, small nodules or ulcers form on the skin, this development is considered unusual. A follow-up visit to a physician should be initiated to rule out serious illness or blunt trauma.
Treatment and therapy
In general, people with heart defects have a higher risk of developing endocarditis. According to the 2007 American Heart Association (AHA) guidelines, which have also been endorsed by the German Society of Cardiology (DGK), prophylactic measures are particularly necessary for patients with heart valve replacements, after surviving endocarditis, with congenital heart defects, and after surviving heart transplantation. In this risk group, antibiotic treatment is urgently required before any surgery, including dental procedures. Patients are issued a cardiac passport that must be carried to every surgery and examination. They should also see the doctor immediately at the slightest sign of an infectious disease so that antibiotic therapy can be initiated as quickly as possible.If allergy to penicillin is present, oral administration of lincosamide may be resorted to.
Outlook and prognosis
The prognosis for Janeway lesion is tied to the causative disease. If inflammation is present, medical care should be sought, otherwise there will be an increase in symptoms. The itching can cause open sores to form on the body, resulting in sepsis in severe cases. This poses a potential threat to the life of the affected person. If a congenital or acquired heart defect is present, the risk of premature death of the patient is increased. If left untreated, cardiac death occurs in many cases. If cardiac surgery is necessary, the associated complications and side effects must be considered when making a prognosis. With early and comprehensive diagnosis and subsequent treatment, the skin lesions can usually be treated well. Within a few days to a few weeks, a regression of the changes in the skin appearance as well as a subsequent freedom from symptoms can be expected. Some patients may develop scarring on the skin during the healing process. Consequential symptoms such as disturbances in sensitivity or an increase in psychological stress due to the visual changes can occur. In addition, there is a possibility of recurrence of the Janeway lesion during life. The prognosis remains unchanged in case of a repeated outbreak of the unpleasant skin changes.
Prevention
So, the above-mentioned risk groups should definitely attend the regular preventive checkups, as well as go to the doctor immediately at the slightest signs of infection. They should also always have their cardiac passport with them. A healthy lifestyle with a balanced diet, adequate sleep, and regular physical activity also helps to strengthen the immune system and thus prevent diseases such as endocarditis and the associated Janeway lesion.
Follow-up
In most cases, the measures of direct aftercare for Janeway lesion are very limited, so sufferers of this disease are primarily dependent on rapid diagnosis with subsequent treatment. This is the only way to avoid further deterioration, which may eventually lead to complications. In the case of the Janeway lesion, no independent healing can occur, 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 the disease is. 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 procedures, the attending physician should be informed about the Janeway lesion to avoid complications during the procedure. Possibly, the life expectancy of the affected person is also reduced due to this disease.
What you can do yourself
Janeway lesion must first be diagnosed and treated by a doctor. However, sufferers can also do some things themselves to relieve symptoms and avoid a severe progression. First, a cardiac passport must be obtained and should be carried to every examination and medical treatment. The underlying heart disease should be treated supportively according to the instructions of a specialist. Depending on the nature of the condition, measures that strengthen the heart, the other organs and the immune system are recommended. Sporting activity is recommended to a certain extent, as is a stress-free lifestyle. In addition, the diet must be changed to avoid further stress on the heart. If signs of an infectious disease develop, 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 medical preparation and should not be exposed to further irritation. Finally, the affected person should take it easy for a few days and arrange further accompanying check-ups with the responsible physician.
