Janeway lesions are painless, small, erythematous or hemorrhagic macules that typically appear on the palms of the hands and the soles of the feet. These lesions are a classic dermatological sign associated with infective endocarditis, an infection of the inner lining of the heart chambers and valves. Unlike Osler nodes, which are also a sign of infective endocarditis but painful and tender, Janeway lesions are not tender because they are the result of microemboli and septic emboli, leading to small abscesses within the dermis. Janeway lesions result from the embolization of infectious material, often bacterial, from the heart valves to the small blood vessels in the skin. The most common pathogens associated with infective endocarditis, and thereby Janeway lesions, include Staphylococcus aureus and Streptococcus species. The emboli cause a localized immune response and the formation of these characteristic lesions.
The primary treatment for Janeway lesions focuses on addressing the underlying infective endocarditis. This typically involves prolonged antibiotic therapy, which may last several weeks, tailored to the specific causative organism identified via blood cultures. In some cases, especially if there is significant damage to the heart valves or persistent infection despite antibiotics, surgical intervention to repair or replace the affected valves may be necessary. As the infection is brought under control, the Janeway lesions usually resolve on their own without the need for direct treatment.
Overall, the presence of Janeway lesions is a significant clinical finding that prompts urgent evaluation for infective endocarditis, a condition that requires timely diagnosis and treatment to prevent severe complications.
