What Are Janeway Lesions? Symptoms, Causes, and More

Medically Reviewed By Uzochukwu Ibe, MD, MPH
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Janeway lesions are painless dark red or purple spots that form on the palms, soles, or under the toes or fingers. They are a common sign of infective endocarditis. Infective endocarditis is an infection of the heart valves or lining. It happens when bacteria, such as staphylococcus aureus, enter the bloodstream and settle in the heart lining.

Most cases of Janeway lesions occur with Osler’s nodes. Osler’s nodes are tender red-to-purple lumps that form on the fingers or toes.

Read on to learn more about Janeway lesions, including their causes, symptoms, and treatment.

What are Janeway lesions? 

an older woman is looking at her hands
Leonardo Borges/Stocksy United

Janeway lesions are skin patches that develop on the palms and feet. They usually last a few days to a few weeks before disappearing.

Most cases of the condition indicate infective endocarditis, a heart infection. Sometimes, it can signify other conditions, such as systemic lupus erythematosus (SLE).

Experts have identified the peculiar characteristics of Janeway lesions as follows:

  • Non-tender: The lesions do not hurt when you touch them.
  • Hemorrhagic: The lesions typically bleed into the skin.
  • Necrotic: The lesions consist of dead tissue.

Janeway lesions and endocarditis 

Janeway lesions are a common manifestation of infective endocarditis. 

Infective endocarditis causes inflammation in the heart’s valves and lining. It is very rare but can be fatal.

According to the American Heart Association (AHA), there are two types of the condition:

  • Acute type: This develops suddenly and progresses quickly. 
  • Subacute or chronic type: This develops slowly over weeks to months.

Other symptoms of infective endocarditis include: 

In some cases, splinter hemorrhages may also occur with infective endocarditis. Splinter hemorrhages are small areas of bleeding under the nail. They result when the blood vessels under the nail bed get damaged.

Seek immediate emergency treatment if you have Janeway lesions or other symptoms of endocarditis.

Osler nodes vs. Janeway lesions 

Janeway lesions commonly occur with Osler’s nodes. 

Osler’s nodes are also a type of skin lesion. They typically have raised edges and a red-to-purple color with a pale center. They typically also have a pale center. 

There are many similarities between Janeway lesions and Osler’s nodes. However, there are noteworthy differences, too.

Osler’s nodes are usually painful, but Janeway lesions are not. Also, Osler’s nodes typically appear on the fingers and toes, but Janeway lesions generally affect the palms and soles.

What do Janeway lesions look like? 

Janeway lesions usually have the following features:

  • Borders: irregular or ill-defined 
  • Elevation: flat
  • Color: red to bluish-red 
  • Distribution: multiple or in clusters 

They may be slightly harder to spot in people with dark skin because the lesions may appear a similar color to a person’s skin.

Show your signs to your doctor for prompt diagnosis and treatment.


Janeway lesions


Red arrows depict the Janeway lesions and black arrows depict the Osler nodules.

Society of General Internal Medicine 2015/NCBI


Janeway lesions are painless. They can vary in color but may be red, brown, or purple.

© 2012 Yan Ji et al/NCBI


Janeway lesions can appear on the palms, soles, or under the toes or fingers. They are a common sign of infective endocarditis.

© 1995-2010, Canadian Medical Association/NCBI

What causes Janeway lesions? 

Janeway lesions are a common sign of infective endocarditis. Infective endocarditis results when bacteria enter the bloodstream and settle in the heart’s lining.

Several types of bacteria can cause infective endocarditis, including:

  • staphylococci
  • streptococci
  • enterococci
  • pseudomonas
  • bartonella

Staphylococci, streptococci, and enterococci are responsible for most cases of infective endocarditis.

Other causative pathogens include: 

  • hemophilus species
  • aggregatibacter species
  • cardiobacterium species
  • eikenella species
  • kingella species

The following factors can increase a person’s risk of infective endocarditis:

  • having a structural or congenital heart disease
  • having prosthetic heart valves
  • having previously undergone invasive procedures
  • using intravenous medicines

The exact reason infective endocarditis causes Janeway lesions is uncertain. However, experts believe bacterial growth in the blood vessels may be involved.

How do you treat Janeway lesions? 

Your doctor will treat Janeway lesions by addressing infective endocarditis. 

The main treatment for infective endocarditis is antibiotics. Examples of antibiotics include:

  • penicillins (Piperacillin)
  • cephalosporins (Cefazolin)
  • carbapenems (Doripenem)

Your doctor will initially conduct some blood tests to determine the most suitable antibiotic to give you. They will also admit you to the hospital so you can receive the antibiotic intravenously or through a drip.

If your condition calls for it, your doctor may complement the antibiotic therapy with surgery. Surgery will focus on repairing the damaged heart valve and draining any abscesses.

Overall, the duration of your treatment will depend on the pathogen involved. 

What is the outlook for Janeway lesions? 

Experts say the appearance of Janeway lesions and Osler’s nodes may indicate a poor outlook for infective endocarditis. 

The lesions may also occur with endocarditis-related complications, such as: 

Infective endocarditis can often be life threatening without prompt treatment. It is important to seek early diagnosis and treatment if you have symptoms. It also helps to take measures to lower your risk of the condition.

These measures include:

  • observing proper oral hygiene
  • taking good care of your skin
  • visiting your dentist for a dental checkup every 6 months
  • taking preventive antibiotics if you have a high risk for infective endocarditis

Remember to speak with your doctor before using preventive antibiotics.


Janeway lesions are skin patches that develop on the palms and feet. They usually indicate infective endocarditis. 

Infective endocarditis causes inflammation in the heart valves or lining. It results when bacteria, such as staphylococcus aureus, enter the bloodstream and settle in the heart lining.

Janeway lesions commonly occur with Osler’s nodes. Osler’s nodes are painful spots with raised edges and a red-to-purple color. 

Treatment for Janeway lesions focuses on addressing infective endocarditis. Methods include antibiotics and surgery.

Make an appointment with your doctor if you have a Janeway lesion or other symptoms of infective endocarditis.

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Medical Reviewer: Uzochukwu Ibe, MD, MPH
Last Review Date: 2022 Nov 18
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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