Pachydermodactyly and atrophia maculosa varioliformis cutis

Pachydermodactyly: a systematic review

INTRODUCTION/OBJECTIVES

Pachydermodactyly is a rare, benign fibromatosis located around the proximal interphalangeal joints. It is often misdiagnosed as juvenile idiopathic arthritis and may cause unnecessary treatments and anxiety in patients. The goal of this paper is to describe this condition through all the existing information in the scientific literature.

METHOD

A systematic review and a descriptive study have been conducted. A systematic research was performed in PubMed, Embase, Cochrane Library and WOS.

RESULTS

Pachydermodactyly was four times more frequent in male subjects and usually started in adolescence. Bilateral presentation was more frequent. History of microtrauma in both hands due to digital manipulation was found in almost half of the patients, many of them showed some neuropsychiatric disorder. In women, the onset happened later, unilateral involvement and family history were more frequent. Swelling of soft tissue without joint implication was found in imaging tests. The progression was usually positive and the treatment included stopping the microtrauma, administrating intralesional corticoids and/or surgery.

CONCLUSIONS

Diagnosis can be established in asymptomatic young patients through a congruent physical exam, regular analytic results and imaging tests that simply show swelling of soft tissue-a biopsy is generally not required for diagnosis. As pachydermodactyly's course is asymptomatic and benign, knowledge about this condition is limited, which increases the likelihood of its underdiagnosis-it is important that clinicians know of pachydermodactyly in order to avoid misdiagnosis.

Monozygotic twins with atrophia maculosa varioliformis cutis

Atrophia maculosa varioliformis cutis (AMVC) is a sporadic or inherited childhood disorder, signified by the occurrence of pitted scars, usually over the face. We report two cases of AMVC occurring in monozygotic twins.

Swollen digits due to pachydermodactyly resembling inflammatory arthritis

Pachydermodactyly is a rare digital fibromatosis, characterized by painless, fusiform swelling in proximal interphalangeal joints. Since it may be misdiagnosed as inflammatory arthritis, it is important to call physicians' attention to this rarely seen condition to avoid unnecessary immunosuppressive treatment. Hereby, we present a case of a pachydermodactyly that had been previously followed-up and treated as an inflammatory arthritis for 4 years. We describe the clinical, radiological, and dermoscopic features of the case.

Pachydermodactyly: Case Report and Review of the Literature

Background:

Pachydermodactyly is a benign form of digital fibromatosis usually presenting in male adolescent patients as asymptomatic nodules on the lateral aspects of the proximal interphalangeal joints of the fingers. It is commonly misdiagnosed as a juvenile rheumatologic condition.

Objective and Conclusion:

Recognition of the features of this disease will assist dermatologists and rheumatologists in making the diagnosis of this rare condition.

Unusual unilateral presentation of pachydermodactyly: a case report

Pachydermodactyly is a rare digital fibromatosis characterized by asymptomatic fusiform soft-tissue swellings of the proximal interphalangeal joints of the hands. It usually affects healthy adolescent males with a negative family history. As a rule, clinical presentation of the disease is bilateral and symmetrical enlargement of the joints. So it can be misdiagnosed with inflammatory rheumatic diseases, especially with juvenile chronic arthritis. A prompt clinical diagnosis of the disease would prevent inappropriate treatment with immunosuppressive agents or steroids and unnecessary expensive diagnostic procedures such as biopsy or magnetic resonance imaging. Once diagnosed, patients should be advised in order to avoid repetitive traumas of the hands, rubbing and cracking of the fingers, obsessive-compulsive use of computer and video games. The joint outcome is always benign. Here, we report a case of pachydermodactyly differs from the typical clinical picture of pachydermodactyly in the unilateral distribution of the lesions.

A Case of Atrophia Maculosa Varioliformis Cutis

Atrophia maculosa varioliformis cutis (AMVC) is a type of idiopathic noninflammatory macular atrophy that occurs in young individuals. It is clinically characterized by shallow, sharply demaracated depressions of various shapes. Considering that atrophia maculosa varioliformis cutis can be mistaken as scarring and artifact dermatitis, it is important for physicians to distinguish this condition and to diagnose it correctly.

A Case of Atrophia Maculosa Varioliformis Cutis

Atrophia maculosa varioliformis cutis is a rare disease that was first described by Heidingsfeld in 1918. It is characterized by an idiopathic, non-inflammatory macular atrophy that typically occurs on the face in young individuals. Despite its association with some diseases, the etiopathogenesis of this entity remains unknown. After consideration of the differential diagnosis criteria for idiopathic atrophic conditions, we report a case for a 40-year-old Korean male whose past medical history was suggestive of atrophia maculosa varioliformis cutis.

Familial atrophia maculosa varioliformis cutis: case report and pedigree analysis

Atrophia maculosa varioliformis cutis (AVMC) was first described in 1918, as a rarely reported form of idiopathic macular atrophy on the cheeks. Nineteen patients have been reported in the past 86 years. Recently we diagnosed a 25-year-old woman as AMVC and investigated her family history. We collected the clinical data of the pedigree and presumed that AVMV is in a autosomal dominant inheritance.

Pachydermodactyly

BACKGROUND

Pachydermodactyly is an infrequently reported disease characterized clinically by painless swelling of the soft tissues at interphalangeal joints. Histopathologic features include increased dermal accumulation of collagen fibers. Young males are predominantly affected. There are only approximately 50 cumulative cases reported worldwide.

OBJECTIVE

: This is a review of 6 new cases of pachydermodactyly from our center.

METHODS

Characteristics of our cases are described in detail and the literature of this disease is reviewed.

RESULTS

The mean disease onset age of our 6 patients was 14 +/- 2.7 years; 5 of the patients were male and 1 was female. Clinical presentations included chronic noninflammatory bulbous swelling of proximal interphalangeal (PIP) joints. Mean numbers of involved joints were 5 +/- 3; most frequently affected were PIP2, 3, and 4 symmetrically. There was 1 patient with monoarticular involvement. X-ray demonstrated soft tissue swelling with no bony or articular damage. Histopathology displayed increased dermal deposition of collagen fibers.

CONCLUSIONS

Pachydermodactyly is not well recognized by rheumatologists and should be differentiated from inflammatory arthritis involving PIP joints.

Atrophia maculosa varioliformis cutis

Atrophia maculosa varioliformis cutis is a rare disease characterized by spontaneously formed facial scars in young adults. Its etiology is unknown; there may be an underlying defect of dermal elastin. We discuss a patient with this unusual disorder and review its literature.

Coxins interfalangeanos sobre paquidermodactilia

Coxins interfalangeanos são nodulações ceratósicas, de limites precisos, com aproximadamente um centímetro de diâmetro, geralmente sobre as articulações interfalangenas das mãos. A paquidermodactilia é uma tumefação uniforme da pele que ocorre nas falanges proximais das mãos. É relatado o caso de um jovem com associação de paquidermodactilia e coxins interfalangeanos, fato não encontrado na literatura médica. Embora haja descrição que considera serem essas manifestações diversas da mesma doença, acredita-se que sejam entidades distintas. O ato compulsivo de atritar a pele parece ser o denominador comum mais aceito para justificar as duas doenças. Os autores postulam que o coxim interfalangeano seria uma resposta epidérmica, enquanto a paquidermodactilia, uma resposta dérmica a um mesmo fator traumático sobre a pele. O paciente foi tratado com infiltração intralesional de triancinolona, com melhora clínica expressiva das duas manifestações.

Familial atrophia maculosa varioliformis cutis

Atrophia maculosa varioliformis cutis (AVMC) was first described by Heidingsfeld in 1918, as a rarely reported form of idiopathic macular atrophy on the cheek (1). It is characterized, clinically, by shallow, sharply demarcated depressions in various shapes. Extrahepatic biliary atresia (2) and pachydermodactyly (3) have been the only conditions associated with AMVC reported in the past 80 years. Although keratosis pilaris is a common skin disorder, it is related to other idiopathic atrophic conditions considered in the differential diagnosis of AMVC, namely keratosis pilaris atrophicans (4). However, the two associations may be coincidental. We observed a patient with keratosis pilaris, and her brother and an unrelated young man, whose findings led to a diagnosis of AMVC.

Familial atrophia maculosa varioliformis cutis: an ultrastructural study

Atrophia maculosa varioliformis cutis is a rare and distinctive form of idiopathic facial macular noninflammatory atrophy that may rarely be observed in members of the same family. We describe two brothers, ages 14 and 16 years, with spontaneously appearing, asymptomatic, varioliform and linear atrophic lesions. Their past medical history was positive for varicella occurring in childhood without residual facial scarring. Routine laboratory investigations and screening for circulating autoantibodies were negative. Both patients were concordant for HLA A2 and DQ4.1. Routine and ultrastructural histologic examination of a punch biopsy specimen showed the presence of scarce, small, fragmented elastic fibers and compact collagen bundles associated with hypertrophic fibroblasts in the dermis. Our patients remained clinically stable, untreated, over a 2-year follow-up period. No long-term follow-up data have previously been reported.

Distal pachydermodactyly

An 80-year-old white woman had a 6-year history of enlarging, intradermal plaques on the distal, volar, and lateral surfaces of the fingers. A biopsy specimen showed whorled, densely aggregated bundles of coarsely thickened collagen within a sparsely cellular papillary and reticular dermis. The fibrosis entrapped eccrine sweat coils and focally extended into the subcutis. This case represents an unusual, predominantly acral form of acquired, progressive, cutaneous fibrosis, which we propose to call distal pachydermodactyly.

[Pachydermodactyly in adolescents: a sign of discomfort?]

BACKGROUND

Pachydermodactyly is an acquired dermatosis related to psychological disturbances.

CASE REPORT

A 16 year-old boy presented with fibrous skin hypertrophy of proximal interphalangeal joint areas of both hands suggestive of pachydermodactyly. Skin biopsy confirmed the fibromatous nature of hypertrophy. The personal history of the child confirmed that pachydermocactyly was due to compulsive rubbing stretching movements in a patient with psychological troubles.

CONCLUSIONS

Pachydermodactyly, mainly observed among male teenagers, must be considered as an induced dermatosis and distinguished from primary fibromatosis.

Pachydermodactyly in two young girls

Pachydermodactyly is a benign, superficial fibromatosis frequently observed in young males. We describe the condition in two young girls affected by Ehlers-Danlos syndrome (EDS) and tuberous sclerosis, respectively. We hypothesized that in the patient with tuberous sclerosis, pachydermodactyly is a clinical manifestation of the associated systemic disease, whereas obsessive-compulsive behavior is probably the main cause in the girl with EDS.

Two cases of pachydermodactyly

We report two cases of pachydermodactyly. Case 1 was a 16-year-old girl who complained of asymptomatic, bulbous, firm swellings which developed insidiously on both sides of the proximal interphalangeal (PIP) joint of her right middle finger. Case 2 was a 14-year-old boy with similar lesions on the sides of the PIP joints of the index and middle fingers of both hands. They both had histories of mild, repetitive mechanical trauma of the fingers. Radiologic findings showed soft tissue swellings without any bony or articular abnormalities. Histopathologic findings from the bulbous swellings revealed marked hyperkeratosis, slight epidermal hyperplasia, and a markedly thickened dermis with a deposition of mucinous material among the collagen fibers. Ultrastructural examinations of both cases showed decreased diameters of collagen fibrils. The lesions temporarily improved with intralesional injection of triamcinolone acetonide. Pachydermodactyly is more commonly found in boys and the affected fingers are more numerous in boys. Both of the present cases had the habit of rubbing and gripping their fingers unconsciously. Mechanical trauma of the fingers around puberty may play an important role in pachydermodactyly.