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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.

Signs and symptoms

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. 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. Although moderate erythema, fine desquamation, or lichenification may occasionally be seen, epidermal alterations are not typically present. There is no impact on hand movements.

Causes

Although the specific cause and etiology are yet unknown, excessive mechanical manipulation of PIP joints is likely to be a contributing factor. The basis for this suggestion is the discovery that pachydermodactyly is related to a variety of jobs and pursuits, including weightlifting, employment in food processing facilities, martial arts, climbing, and individuals with OCD who have hand tics.

Diagnosis

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. 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.

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. In addition, there may be a decrease in mucin and elastic fibers, as well as hyperkeratosis (orthokeratosis or parakeratosis).

Hand radiographs usually show soft tissue swelling without interphalangeal joint structural involvement. An X-ray examination shows no abnormalities in the periosteum or bones in pachydermodactyly patients. Additionally, no changes are seen in the synovium or joints during ultrasound.

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.

Differential diagnoses include rheumatoid arthritis, acromegaly, juvenile idiopathic arthritis, pachydermoperiostosis, knuckle pads, and juvenile digital fibromatosis.

Treatment

Pachydermodactyly does not currently have a commonly accepted treatment. Nevertheless, aggressive therapy is usually not necessary due to the disease's benign course. Since the majority of pachydermodactyly cases appear with symptoms caused by recurrent joint trauma, discontinuing stimulating activities is sufficient to promote regression or stabilization. It has also been demonstrated that intralesional corticosteroids can sometimes reduce swelling. Intralesional triamcinolone injections have also been reported to alleviate symptoms. Pachydermodactyly patients frequently have surgery to improve the appearance of a digit.

See also

• Skin lesion

References

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4. ^ 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.
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6. ^ 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.
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16. 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.
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18. 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.
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20. 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.
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Further reading

• 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.

External links

• DermNet
• VisualDx

• Dermal and subcutaneous growths