What are the other Names for this Condition? (Also known as/Synonyms)

• JL (Janeway Lesion)

What is Janeway Lesion? (Definition/Background Information)

• Janeway Lesions are uncommon and painless, small skin lesions observed on the palms or soles, which are typically associated with an underlying condition, most commonly infective endocarditis (or bacterial endocarditis)
• Infective endocarditis is an infection of the heart valves or the heart’s inner lining, known as the endocardium. It occurs when infection from other parts of the body enter the bloodstream (usually resulting in bacteremia) and attack the lining of the heart or the heart valves
• Janeway Lesions are indicators of serious medical illnesses, such as infective endocarditis, and can potentially help the healthcare provider in early diagnosis/treatment of the same. Other rare conditions that Janeway Lesions are associated with include systemic lupus erythematosus and hemolytic anemia, among others

Who gets Janeway Lesion? (Age and Sex Distribution)

• Janeway Lesion are observed in individuals with certain medical conditions, chiefly infective endocarditis
• Both males and females may be affected
• Worldwide, there is no racial or ethnic preference observed

What are the Risk Factors for Janeway Lesion? (Predisposing Factors)

The risk factors for Janeway Lesion include:

• Infective endocarditis is the primary predisposing factor for Janeway Lesions
• Other diseases and conditions in which these lesions are observed rarely include:
  • Disseminated gonorrhea
  • Hemolytic anemia
  • Systemic lupus erythematosus (SLE)
  • Typhoid fever

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Janeway Lesion? (Etiology)

• Janeway Lesions are due to “septic micro-emboli”, meaning these skin tissue lesions (in the dermis) are micro-abscesses that are formed by the deposition of contaminated particles and bacteria by blood
• The origin of bacteria is related to the underlying medical condition, most commonly infection of the endocardium/heart valves (usually by Staphylococcus aureus bacterium)

What are the Signs and Symptoms of Janeway Lesion?

The signs and symptoms of Janeway Lesion may include:

• Presence of red to dark red spots beneath the skin of the soles or palms
• Janeway Lesions are small-sized - about a few mm in size
• These lesions may be in the form of papules (raised bumps on skin), macules (flat and discolored areas with well-defined borders), or rarely, nodules
• In most cases, the lesions are present at the base of the thumb or little finger (particularly with infective endocarditis)
• No pain or discomfort is observed; the lesions are also non-tender

Additional signs and symptoms of the underlying condition, such as infective endocarditis, may be noted.

How is Janeway Lesion Diagnosed?

A diagnosis of Janeway Lesion may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Investigative studies to diagnose the underlying condition causing Janeway Lesions is important
• Blood tests and culture studies, as needed
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Since Janeway Lesions are similar to Osler nodes, another form of skin lesions that arise from an underlying medical condition (notably infective endocarditis), a differential diagnosis to exclude them may be performed.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Janeway Lesion?

There are no significant complications from Janeway Lesions. However, complications may be noted from the underlying causative condition, which can be severe and life-threatening.

How is Janeway Lesion Treated?

There is no specific treatment necessary for Janeway Lesions; the skin lesions are generally self-resolving. The healthcare provider will undertake appropriate treatment of the underlying condition, such as infective endocarditis, which is important.

How can Janeway Lesion be Prevented?

A prevention of Janeway Lesion is dependent on taking suitable measures to prevent the underlying cause, which includes infective endocarditis, hemolytic anemia, typhoid, disseminated gonococcal infection, or systemic lupus erythematosus.

What is the Prognosis of Janeway Lesion? (Outcomes/Resolutions)

• Janeway Lesions are typically self-limited lesions that are known to last for a few days to weeks before disappearing completely (even in the absence of any suitable treatment)
• However, the overall prognosis is based on the promptness of diagnosing the underlying medical condition causing Janeway Lesions, and undertaking an appropriate management of the same

Additional and Relevant Useful Information for Janeway Lesion:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/diseases-conditions/infective-endocarditis/