Pachydermodactyly
| Pachydermodactyly | |
|---|---|
| Specialty | Dermatology |
Pachydermodactyly is a superficial dermal fibromatosis that presents as a poorly circumscribed symmetric, infiltrative, asymptomatic soft-tissue hypertrophy of the proximal fingers, typically sparing the thumbs and fifth fingers and rarely extending proximally to the wrists or occurring distally.[1]: 990
Signs and symptoms
[edit]Pachydermodactyly is defined by gradual, asymptomatic thickening of the periarticular skin and soft tissue swelling, mainly affecting the lateral sides of the fingers' proximal interphalangeal (PIP) joints.[2][3] The most commonly affected fingers are the second, third, and fourth; however, the dorsum of the hand and the fifth finger may also be affected.[4] Although moderate erythema, fine desquamation, or lichenification may occasionally be seen, epidermal alterations are not typically present.[5] There is no impact on hand movements.[6]
Causes
[edit]Although the specific cause and etiology are yet unknown, excessive mechanical manipulation of PIP joints is likely to be a contributing factor.[7] The basis for this suggestion is the discovery that pachydermodactyly is related to a variety of jobs and pursuits, including weightlifting,[6] employment in food processing facilities,[8] martial arts, climbing,[9] and individuals with OCD who have hand tics.[10]
Diagnosis
[edit]The final diagnosis is clinical and made after ruling out other possible causes of joint swelling. It calls for a high degree of suspicion, especially in individuals who have progressive soft tissue swelling without any pain, soreness, or diminished function.[11] Unless clinically indicated, laboratory testing such as extractable nuclear antigen test, rheumatoid factor, C-reactive protein, complete blood count, and antinuclear factor are not required.[12]
A thickening of the dermis, possibly associated with a benign proliferation of fibroblasts, and an increase in collagen fibers that extend to the subcutaneous cellular tissue are the most common histological findings.[6] In addition, there may be a decrease in mucin and elastic fibers, as well as hyperkeratosis (orthokeratosis or parakeratosis).[4]
Hand radiographs usually show soft tissue swelling without interphalangeal joint structural involvement.[13] An X-ray examination shows no abnormalities in the periosteum or bones in pachydermodactyly patients.[14] Additionally, no changes are seen in the synovium or joints during ultrasound.[15]
Chen et al. published a diagnostic criterion that consists of six elements: the patient having no symptoms; there being no stiffness in the morning; no restriction on movement; swelling on the lateral aspect of the finger; normal laboratory values; and soft tissue swelling on radiography.[16]
Differential diagnoses include rheumatoid arthritis, acromegaly, juvenile idiopathic arthritis, pachydermoperiostosis, knuckle pads, and juvenile digital fibromatosis.[17]
Treatment
[edit]Pachydermodactyly does not currently have a commonly accepted treatment.[18] Nevertheless, aggressive therapy is usually not necessary due to the disease's benign course.[19] Since the majority of pachydermodactyly cases appear with symptoms caused by recurrent joint trauma, discontinuing stimulating activities is sufficient to promote regression or stabilization.[20] It has also been demonstrated that intralesional corticosteroids can sometimes reduce swelling.[citation needed] Intralesional triamcinolone injections have also been reported to alleviate symptoms.[6] Pachydermodactyly patients frequently have surgery to improve the appearance of a digit.[21]
See also
[edit]References
[edit]- ^ Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- ^ Liew, Amanda Ling Fung; Ting, Yonghan (2020-05-19). "Pachydermodactyly: A Case Report of a Little-Known and Benign Form of Digital Fibromatosis". American Journal of Case Reports. 21. International Scientific Information, Inc.: e923344. doi:10.12659/ajcr.923344. ISSN 1941-5923. PMC 7262483. PMID 32424112.
- ^ Vázquez Fernández, Ricardo; Maneiro Fernández, José Ramón; Cervantes Pérez, Evelin Cecilia; Mera Varela, Antonio (2020-10-01). "Pachydermodactyly: a systematic review". Irish Journal of Medical Science (1971 -). 190 (3). Springer Science and Business Media LLC: 1005���1014. doi:10.1007/s11845-020-02378-1. ISSN 0021-1265. PMID 33006046.
- ^ a b Beltraminelli, Helmut; Itin, Peter (2009). "Pachydermodactyly – Just a sign of emotional distress". European Journal of Dermatology. 19 (1): 005–013. doi:10.1684/ejd.2008.0543. ISSN 1167-1122. PMID 19059823.
- ^ Meunier, L.; Pailler, C.; Barneon, G.; Meynadier, J. (1994). "Pachydermodactyly or acquired digital fibromatosis". British Journal of Dermatology. 131 (5). Oxford University Press (OUP): 744–746. doi:10.1111/j.1365-2133.1994.tb05006.x. ISSN 0007-0963. PMID 7999628.
- ^ a b c d Plana Pla, A.; Bassas Vila, J.; Toro Montecinos, M.A.; Ferrandiz Foraster, C. (2014). "Pachydermodactyly Successfully Treated With Triamcinolone Injections". Actas Dermo-Sifiliográficas (English Edition). 105 (3). Elsevier BV: 319–321. doi:10.1016/j.adengl.2013.04.024. ISSN 1578-2190. PMID 24657023.
- ^ Dallos, Tomáš; Oppl, Bastian; Kovács, László; Zwerina, Jochen (2014). "Pachydermodactyly: A Review". Current Rheumatology Reports. 16 (9). doi:10.1007/s11926-014-0442-7. ISSN 1523-3774. PMID 25173950.
- ^ Sagransky, Matthew J.; Pichardo-Geisinger, Rita O.; Muñoz-Ali, Diana; Feldman, Steven R.; Mora, Dana C.; Quandt, Sara A. (2012-08-01). "Pachydermodactyly From Repetitive Motion in Poultry Processing Workers: A Report of 2 Cases". Archives of Dermatology. 148 (8): 925–928. doi:10.1001/archdermatol.2012.983. ISSN 0003-987X. PMID 22911188.
- ^ Morales Callaghan, A. M.; Horndler Argarate, C.; García Latasa de Araníbar, F. J.; Zubiri Ara, M. L. (2010). "[Pachydermodactyly: a rare form of acquired digital fibromatosis]". Actas Dermo-Sifiliograficas. 101 (7): 652–654. doi:10.1016/S1578-2190(10)70693-4. ISSN 1578-2190. PMID 20858397.
- ^ Lautenschlager, S.; Itin, P. H.; Rufli, T. (1994). "Pachydermodactyly: reflecting obsessive-compulsive behavior?". Archives of Dermatology. 130 (3): 387. doi:10.1001/archderm.1994.01690030123021. ISSN 0003-987X. PMID 8129422.
- ^ Barnes, Leandra A.; Bae, Gordon H.; Lewis, Matthew A.; Rieger, Kerri E. (2018). "Pachydermodactyly: Case report including clinical and histopathologic diagnostic pitfalls". Journal of Cutaneous Pathology. 45 (12): 949–953. doi:10.1111/cup.13359. ISSN 0303-6987. PMID 30221379.
- ^ Sinha, NK; Ling, SP; Nema, SK; Pai, DR (2013). "Pachydermodactyly does not need rheumatologic work-up". Journal of Postgraduate Medicine. 59 (4). Medknow: 335–336. doi:10.4103/0022-3859.123182. ISSN 0022-3859. PMID 24346401.
- ^ Leung, Alexander K.C.; Lam, Joseph M. (2021). "Pachydermodactyly". The Journal of Pediatrics. 236. Elsevier BV: 316–317. doi:10.1016/j.jpeds.2021.05.049. ISSN 0022-3476. PMID 34029598.
- ^ Żuber, Zbigniew; Dyduch, Grzegorz; Jaworek, Andrzej; Turowska-Heydel, Dorota; Sobczyk, Małgorzata; Banach-Górnicka, Marta; Rusnak, Katarzyna; Górecki, Wojciech (2016-06-30). "Pachydermodactyly – a report of two cases". Rheumatology. 54 (3). Termedia Sp. z.o.o.: 136–140. doi:10.5114/reum.2016.61215. ISSN 0034-6233. PMC 4967981. PMID 27504024.
- ^ Rachowska, Regina; Filipowska-Grońska, Agata; Weryńska-Kalemba, Maria; Bożek, Andrzej; Filipowska, Barbara; Zajęcki, Wojciech; Ilczuk, Danuta; Herba, Monika; Jarząb, Jerzy (2010). "Case report Pachydermodactyly – a case report". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii (in Polish). 27 (6). Termedia. ISSN 1642-395X. Retrieved 2024-05-01.
- ^ Chen, Chen-Kuan; Shyur, Shyh-Dar; Chu, Szu-Hung; Huang, Li-Hsin; Kao, Yu-Hsuan; Liu, Ling-Chun (2015). "Pachydermodactyly: Three new cases in Taiwan". Journal of Microbiology, Immunology and Infection. 48 (3). Elsevier BV: 340–344. doi:10.1016/j.jmii.2012.09.002. ISSN 1684-1182. PMID 23218407.
- ^ Liu, Wei; Ma, Dong-Lai (2020). "Pachydermodactyly". Mayo Clinic Proceedings. 95 (10). Elsevier BV: 2280–2281. doi:10.1016/j.mayocp.2020.08.013. ISSN 0025-6196. PMID 33012355.
- ^ Hussain, Salman; Ehtesham, Maryam; Almas, Talal; Aldei, Ali (2021). "Painful pachydermodactyly in a 39-year-old woman: A case report and review of the literature". Annals of Medicine and Surgery. 70. Ovid Technologies (Wolters Kluwer Health): 102871. doi:10.1016/j.amsu.2021.102871. ISSN 2049-0801. PMC 8519772. PMID 34691419.
- ^ CHU, HOWARD; SONG, JUNGSIK; KIM, DO YOUNG (2016). "Pachydermodactyly: A Benign Cutaneous Condition that May Be Misdiagnosed as a Joint Disorder". The Journal of Rheumatology. 43 (8): 1615–1616. doi:10.3899/jrheum.160242. ISSN 0315-162X.
- ^ Tariq, Halla; Ihsan, Aroosha; Khan, Dr Asadullah; Shamim, Roshila (2023-01-25). "Pachydermodactyly, mimicker of rheumatoid hands, presents in a patient with Tuberous Sclerosis". Pakistan Journal of Medical Sciences. 39 (2): 624–627. doi:10.12669/pjms.39.2.6631. ISSN 1681-715X. PMC 10025706. PMID 36950423.
- ^ Kato, Naoki; Niitsu, Mamoru; Kawabe, Tetsuya; Arai, Eiichi; Fukumoto, Keizo (2015). "Surgical Management of Unilateral Soft Tissue Swelling around the Proximal Interphalangeal Joint in an Adolescent: A Case Report of Pachydermodactyly". Case Reports in Orthopedics. 2015. Hindawi Limited: 1–4. doi:10.1155/2015/242078. ISSN 2090-6749. PMC 4672109. PMID 26688765.
Further reading
[edit]- Requena, Camila Bueno; Miot, Hélio Amante; Marques, Mariângela Esther Alencar; Miot, Luciane Donida Bartoli (2014). "Case for diagnosis". Anais Brasileiros de Dermatologia. 89 (2). FapUNIFESP (SciELO): 359–360. doi:10.1590/abd1806-4841.20142689. hdl:11449/109580. ISSN 0365-0596.
- Gallardo-Villamil, Andrea; Cano-Aguilar, Luis E; Pérez-Muñoz, Estela; Rojas-Maruri, Mauricio; Saez de Ocariz, Marimar (2023-07-15). "Pachydermodactyly: Soft Tissue Enlargement of the Fingers in a Teenager". Cureus. Springer Science and Business Media LLC. doi:10.7759/cureus.41923. ISSN 2168-8184. PMC 10425703. PMID 37588310.