|THROUGH THE LENS
|Ahead of print publication
The boy with thick fingers
Rajsmita Bhattacharjee, Adithya Nagendran, Vinay Keshavamurthy
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab, India
|Date of Web Publication||29-May-2019|
Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, Punjab - 160 012
Source of Support: None, Conflict of Interest: None
An eleven-year-old boy presented with progressive, painless, swelling of the skin overlying proximal interphalangeal joints of both hands since past year [Figure 1]a. There was no history of arthralgia or repeated mechanical stimulation of the involved skin. Examination revealed thickening and induration of the skin overlying the second through fifth proximal interphalangeal joints of both hands (right more than left), with slight deviation of the affected fingers. X-ray of the hands showed soft tissue thickening without any joint abnormality [Figure 1]b. Based on the clinical and radiological findings corroborated by histopathology, a diagnosis of pachydermodactyly (PDD) was rendered.
|Figure 1: (a) Thickening and induration of the skin overlying the second through fifth proximal interphalangeal joints of both hands (right more than left), with slight deviation of the affected fingers. (b) X-ray of the hands showed soft tissue thickening without any joint abnormality|
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PDD is a rare, benign digital soft tissue fibromatosis mostly affecting young men. The underlying pathogenesis remains speculative though mechanical stimulation is implied in its causation., It has also been associated with many psychiatric disorders including mental retardation and Asperger syndrome. It can present with joint pain in addition to cutaneous involvement, and hence can be confused with close differential diagnoses such as juvenile idiopathic arthritis, rheumatoid arthritis, pachydermoperiostosis, thyroid acropachy, acromegaly, and knuckle pads. Treatment involves cessation of mechanical stimulation and treatment of any underlying psychiatric condition.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Dallos T, Oppl B, Kovacs L, Zwerina J. Pachydermodactyly: A review. Curr Rheumatol Rep 2014;16:442.
Schneider SL, Patel D, Shwayder TA. Teenage boy with thickened dorsal hands and feet. Pediatr Dermatol 2017;34:719-20.