trip hand images

We’re sorry, but Freepik doesn’t work properly without JavaScript enabled. FAQ Contact

AI-generated image

From your imagination to a tangible image in just a few words

From social media posts or prints to any other layouts, and everything in between

See your designs in action on apparel, packaging or prints

• Notifications
• Go back Remove
• No notifications to show yet You’ll see useful information here soon. Stay tuned!
• Downloads 0/60 What is this?
• My collections
• My subscription
• Vacation planning
• Travel agent
• Travel airport
• Travel agency
• Travel technology
• Holiday travel

Travel Hand Images

• Add to collection
• Save to Pinterest

• doodle illustration

• background travel
• travel world
• tourism traveling

• flying plane

• hand sanitizer

• banner travel

• airplane background

• hand holding

• airplane poster
• holiday poster

• airplane travel
• airplane flying

• notebook template

• travel visa

• beach landscape

• thumbnail youtube

• plane top view

• happy person

• A photo Photos   10k
• Pen Tool Illustrations   1.6k
• A stack of folders Collections   31k
• A group of people Users   464

Browse premium images on iStock | Claim your discount now

Make something awesome

Are you a healthcare professional

GO TO DERMNET PRO

Common skin conditions

Check out what's new with DermNet

Quick links

Skin checker

Try our skin symptom checker

Tripe palms

Tripe palms — extra information.

Systemic diseases

Authors: Kelvin Truong, Dermatology Research Fellow; Raquel Ruiz Araujo, Specialist Dermatologist, Westmead Hospital, New South Wales, Australia. Copy edited by Gus Mitchell. February 2022

" data-index="1" alt="Go to Introduction " onclick="event.preventDefault();document.getElementsByTagName('h2')[(1 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Introduction " data-index="2" alt="Go to Demographics " onclick="event.preventDefault();document.getElementsByTagName('h2')[(2 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Demographics " data-index="3" alt="Go to Causes " onclick="event.preventDefault();document.getElementsByTagName('h2')[(3 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Causes " data-index="4" alt="Go to Clinical features " onclick="event.preventDefault();document.getElementsByTagName('h2')[(4 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Clinical features " data-index="5" alt="Go to Diagnosis " onclick="event.preventDefault();document.getElementsByTagName('h2')[(5 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Diagnosis " data-index="6" alt="Go to Differential diagnoses " onclick="event.preventDefault();document.getElementsByTagName('h2')[(6 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Differential diagnoses " data-index="7" alt="Go to Treatment " onclick="event.preventDefault();document.getElementsByTagName('h2')[(7 - 1)].scrollIntoView({behavior: 'smooth',block: 'start'});">Treatment Outcome

What are tripe palms?

Tripe palms are a very rare skin condition affecting the palms of hands and soles of feet; it is characterised by thickened skin resembling the stomach lining of some animals (tripe).

Tripe palms, also known as acanthosis palmaris or acquired pachydermatoglyphia, are frequently associated with internal malignancy. Tripe palms are a paraneoplastic dermatosis ; a group of skin conditions that are caused by cancer and share the same underlying genetic basis. It often coexists with acanthosis nigricans .

Tripe palms 

Acanthosis nigricans 

Who gets tripe palms?

There are approximately 100 cases of tripe palms reported in medical literature. It is more common in males than in females.

Approximately 90% of cases of tripe palms are associated with internal malignancy. Skin changes may precede the diagnosis of, or develop during, malignancy.

Tripe palms has also been associated with non-cancerous conditions such as:

• Bullous pemphigoid
• Exfoliative dermatitis .

What causes tripe palms?

The exact mechanism through which tripe palms develops is unknown. It is thought that the cancer cells secrete growth factors , such as epidermal growth factor -α and transforming growth factor-α, causing growth of skin cells (or more specifically keratinocytes ) and hence the appearance of tripe palms.

Cancers that have frequently been associated with tripe palms include:

• Gastric cancer
• Lung cancer.

And less frequently:

• Breast cancer
• Genitourinary tract cancers.

What are the clinical features of tripe palms?

Typically, patients with tripe palms present with thickened skin on the palms of their hands. This thickening can accentuate dermatoglyphic change which appears as a velvety pattern. The thickening often gives a yellow hue to the skin. These features are akin to the lining of the stomach, hence the skin condition being termed tripe palms. The soles of feet can also be affected.

Tripe palms usually coexists with malignant acanthosis nigricans in approximately 7 of 10 cases. Acanthosis nigricans is a skin condition that describes the darkening and velvety appearance of body folds, such as the neck, armpits, and groin.

Tripe palms can be found alongside:

• Clubbing of the fingernails (1 in 5 persons)
• Itchiness of the skin (1 in 4 persons)
• Cutaneous papillomatosis
• Multiple fast growing seborrhoeic keratosis ( sign of Leser-Trélat ).

How are tripe palms diagnosed?

Tripe palms are diagnosed clinically. A biopsy of the skin is not helpful in confirming the diagnosis, as the histologic findings are non-specific.

What is the differential diagnosis for tripe palms?

The clinical appearance of tripe palms can be like:

• Acrokeratosis paraneoplastica
• Hypertrophic pulmonary osteoarthropathy
• Pachydermoperiostosis
• Palmoplantar keratoderma
• Thyroid acropachy .

What is the treatment for tripe palms?

Patients presenting with tripe palms and without a history of cancer need to be worked up for malignancy. This includes:

• Thorough medical history
• Complete physical examination
• Further investigations based on the findings.

The treatment of tripe palms is challenging. As tripe palms are very rare, there is limited high quality evidence to guide its management. Management with oral retinoids have helped.

What is the outcome for tripe palms?

Approximately 3 out of 10 cases of tripe palms resolve when the underlying cancer is managed. However, tripe palms may persist despite remission of the underlying cancer.

Bibliography

• Barman B, Devi LP, Thakur BK, Raphael V. Tripe Palms and Acanthosis Nigricans: A Clue for Diagnosis of Advanced Pancreatic Adenocarcinoma. Indian Dermatol Online J. 2019;10(4):453–5. 10.4103/idoj.IDOJ_427_18. Journal
• Cohen PR, Grossman ME, Almeida L, Kurzrock R. Tripe palms and malignancy. Journal of Clinical Oncology. 1989;7(5):669–78. 10.1200/jco.1989.7.5.669. Journal
• Danesh MJ, Saylor DK, Leard LE, North JP, Fox LP. Acquired acanthosis nigricans with tripe palms in a patient with interstitial lung disease. JAAD Case Reports. 2016;2(1):59–62. 10.1016/j.jdcr.2015.11.008. PubMed Central
• Pipkin CA, Lio PA. Cutaneous manifestations of internal malignancies: an overview. Dermatol Clin. 2008;26(1):1–15, vii. 10.1016/j.det.2007.08.002. Journal
• Requena L, Aguilar A, Renedo G, et al. Tripe palms: a cutaneous marker of internal malignancy. J Dermatol. 1995;22(7):492–5. Journal
• Silva JA, Mesquita Kde C, Igreja AC, et al. Paraneoplastic cutaneous manifestations: concepts and updates. An Bras Dermatol. 2013;88(1):9–22. 10.1590/s0365-05962013000100001. Journal
• Thiers BH, Sahn RE, Callen JP. Cutaneous manifestations of internal malignancy. CA Cancer J Clin. 2009;59(2):73–98. doi:10.3322/caac.20005. Journal
• Cutaneous markers of internal malignancy
• Hypertrophic osteoarthropathy and digital clubbing

Other websites

• Dermatologic manifestations of paraneoplastic syndromes — Medscape

Books about skin diseases

• Books about the skin
• Dermatology Made Easy  - second edition

Other recommended articles

TrendMD recommendations failed to load. Please refresh the page.

• UK Politics
• News Videos
• Paris 2024 Olympics
• Rugby Union
• Sport Videos
• John Rentoul
• Mary Dejevsky
• Andrew Grice
• Sean O’Grady
• Photography
• Theatre & Dance
• Culture Videos
• Fitness & Wellbeing
• Food & Drink
• Health & Families
• Royal Family
• Electric Vehicles
• Car Insurance Deals
• Lifestyle Videos
• UK Hotel Reviews
• News & Advice
• Simon Calder
• Australia & New Zealand
• South America
• C. America & Caribbean
• Middle East
• Politics Explained
• News Analysis
• Today’s Edition
• Home & Garden
• Broadband deals
• Fashion & Beauty
• Travel & Outdoors
• Sports & Fitness
• Climate 100
• Sustainable Living
• Climate Videos
• Solar Panels

Behind The Headlines

On the ground, decomplicated.

• You Ask The Questions

Binge Watch

Travel smart.

• Watch on your TV
• Crosswords & Puzzles
• Most Commented
• Newsletters
• Ask Me Anything
• Virtual Events
• Wine Offers
• Betting Sites

Thank you for registering

Please refresh the page or navigate to another page on the site to be automatically logged in Please refresh your browser to be logged in

Independent TV

Showing now | culture.

Holly Patrick | Monday 02 September 2024 16:17 BST

George Clooney tries hand at red carpet photography at Venice Film Festival

George Clooney stepped in as a red carpet photographer at the 81st Venice Film Festival on Sunday, 1 September.

The Wolfs actor was in Italy promoting his new film when he and co-star Brad Pitt jumped either side of the red carpet in amongst press members.

On the same night, Clooney rushed over to help a photographer who had fallen over as he and his wife Amal Clooney posed for pictures.

Clooney and Pitt star in the upcoming Apple TV+ drama about two professional fixers who are forced to work together on a job despite their desire to operate as lone wolves.

Lauryn Goodman’s message to Kyle Walker during This Morning interview

Ian McKellen recalls stage fall in first TV interview since accident

Jude Law and Nicholas Hoult receive seven-minute standing ovation

Nick Grimshaw makes confession after 40th birthday Ibiza trip

Editor’s picks.

Why France is your perfect autumnal getaway

Leila Farzad talks Kaos, The Decameron and finding the audience

How to travel sustainably around Europe by train

Olympic climbers Erin McNeice and Shauna Coxsey share tips on strength

Go to where the wild things are with a safari holiday

Team GB’s table tennis Olympians on how to get quicker

How did social media fuel the Southport rioters?

How to train like an Olympian: TeamGB’s Adam Burgess on decisions

Searching for the ‘Whitby Woman’

On the campaign trail with Sir Jacob Rees-Mogg

Life at 50C: Delhi’s streets struggling to cope with heatwave

Indian farmers use election to make voices heard against Narendra Modi

Baltimore will rebuild, but at what cost? | On The Ground

New Yorkers turn to self-defence classes as punching attacks continue

This 26-year-old could be Biden’s secret weapon | On The Ground

The NHS nurse fighting to be heard | On The Ground

What would a President Trump 2.0 look like?

When will the Cost of Living Crisis end?

How airlines greenwash the skies

Is it time to panic over AI? | Behind The Headlines

My personal struggle amid the global fight for abortion rights

Non-doms, ghost-doms and tax loopholes of the elite

The fight for LGBT+ rights in Poland

The war in Ukraine | Behind The Headlines

What is tactical voting - and why could it be a powerful tool?

Are ultra-processed foods bad for you?

Why are UK councils going bankrupt?

What causes the winter flu and how does it differ from other types?

How does the Iowa Caucus pick the next US president? | Decomplicated

Everything you need to know about the bedbug invasion | Decomplicated

What is Raac and why is it causing an issue in schools?

How does El Niño affect our weather? | Decomplicated

Viggo Mortensen on the role that got away

Ryan Gosling and Emily Blunt pick their go-to karaoke songs

Actor Kevin Durand on how he found his inner ape

Go to Bat with Melanie Lynskey: My film that deserves more love

Oscars 2024: Who will win Best Actor and Actress?

Oscars 2024: Who will win Best Picture and Best Director?

Big Brother’s Jordan and Henry on life after the house

Lemoncello perform ‘Old Friend’ in Music Box session

Lemoncello perform ‘Sunflower’ in Music Box session

Boston trio Tiny Habits perform ‘Wishes’ for Music Box session

Boston trio Tiny Habits perform ‘Mudroom’ in Music Box session

The Mysterines perform ‘The Last Dance’ for Music Box

Rock band The Mysterines perform single ‘Stray’ for Music Box

Gareth Dunlop performs ‘Church’ in acoustic live set

Irish pop artist Gareth Dunlop performs Go Down Swinging for Music Box

The splendour along Lake Geneva as Montreux Jazz Festival plays

Exploring the wilds of the Atlantic Islands

How to spend your summer in Scotland

How to master the art of the last minute holiday

How to island hop around the Caribbean like a pro

Here’s why Greece is still a firm family summer holiday favourite

Cousin of Israeli hostage killed by Hamas pays tribute

David Davis believes it’s ‘highly likely’ Lucy Letby is innocent

President Biden responds to Trump’s Arlington cemetery behavior

Norwegian princess marries shaman in front of star-studded audience

Scuffles break out in Tel Aviv between police and protesters

Boy returns to museum where he broke 3,500-year-old ancient jar

Matt Bush praises coaches after securing historic taekwondo gold

‘Hero’ Blackpool police officer pulls woman from sea as tide rises

Erik ten Hag clashes with journalist after 3-0 Liverpool defeat

Sean Dyche says Everton’s collapse ‘most frustrating’ defeat of career

Jadon Sancho reveals what Chelsea fans can expect from him this season

Gary Lineker pays tribute to Sven-Goran Eriksson on Match of the Day

Judy Murray didn’t enjoy last five years of Andy’s tennis career

Sterling sends message to Arsenal fans after completing loan move

Pep Guardiola claims ‘not even defender with gun’ could stop Haaland

Kadeena Cox addresses fall that ended Paralympics gold medal hopes

Surfers ride powerful 13ft waves amid weather warning

Floodwaters rage across Yelville as residents evacuated from homes

Greece shuts down Acropolis as temperatures hit almost 40 degrees

Eerie tornado sirens ring through downtown Chicago

Googlebox stars stuck in Jamaica as Hurricane Beryl makes landfall

Damaged boats sink in port after Hurricane Beryl lashes Barbados

Northern California wildfire forces thousands to evacuate

Cars swept away in New Mexico flash floods after wildfires

Jessica Alba surprises father by renovating his childhood home

Brad Pitt goes public with girlfriend at 81st Venice Film Festival

Rihanna replaces Charlize Theron in new J’Adore Dior campaign

Moment possum pops up out of car hood to shock driver

Watch: Angela Rayner dances behind DJ booth inside Ibiza nightclub

Teacher criticises parents for sending kids to school with cupcakes

Saudi Cup: ‘A true display of horsemanship’, says Prince Bandar

Princess Nourah praises young fashion designers on show at Saudi Cup

Andrew Strauss says Saudi is an eye opener

Saudi Arabia is ‘pushing limits’ of fashion creativity

Saudi Cup could become ‘the best race in the world’

Horseracing chiefs praise Saudi Cup

Saudi will become a ‘worldwide, year-long’ horseracing destination

Arabian horses ‘big part’ of global racing culture, says Damien Oliver

Galaxy the ripple effect.

Ebony Rainford-Brent MBE on the imposter syndrome epidemic

Finance coach Ellie Austin-Williams on the psychology of money

Ebony Rainford-Brent MBE on how to tackle imposter syndrome

Simple ways to boost your money situation with Ellie Austin-Williams

E.on next power switch.

Episode One - Cooking

Episode Two - Entertainment

Episode Three - Body Care

Episode Four - Lighting

Big in america.

Can Willsow’s children’s books pique the interest of the US market?

Will the founders of Spice Kitchen be able to find US retailers?

Co-founders of See.Sense bring their cycle safe tech to New York City

Collctiv fintech founder Amy Whitell tries to crack the US tech market

The maritime tech guru taking high-speed ferries across the Atlantic

Saudi green initiative.

Saudi government doesn’t ‘pay lip service’ on climate action

SGI ‘seems like a nest of harmony’, journalist says

SGI ambitions are ‘extremely high’, says Saudi climate envoy

Saudi Green Initiative aims to ‘not just preserve, but create’

Expert explains how ‘blended finance’ can help achieve net zero

SGI can be a ‘catalyst’ for Saudi Arabia, head of SABB says

Kaust professor ‘inspired’ by Saudi efforts to save coral reefs

Watch in full: Day two of the Saudi Green Initiative Forum

Gérard Mestrallet on the challenges of bringing infrastructure to the region of AlUla

Sir George Iacobescu, chairman of the Canary Wharf Group on the investment into the historic region of AlUla

Oliver Ripley of sustainable hotel group Habitas talks about how AlUla challenged his preconceptions of Saudi Arabia

Thomas Kaplan of wild cat conservation charity Panthera on the mission to save the Arabian Leopard

How AlUla’s sustainability plan will stand the test of time - webinar

Discover AlUla: The Journey Through Time

AlUla Oasis View Trail

Stargazing Experience