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Achenbach syndrome

Author: Dr Ian Coulson, Consultant Dermatologist, East Lancashire NHS Trust, Lancashire, UK. Copy edited by Gus Mitchell. September 2021


What is Achenbach syndrome?

Achenbach syndrome is a paroxysmal recurring painful bruising of the finger(s) or palm, not associated with serious underlying conditions.

Achenbach syndrome of the fingers

Who gets Achenbach syndrome?

Achenbach syndrome has been predominantly reported in middle-aged females, with a median age of onset of 48–50 years (range 22–76).

Although said to be rare, a study of 802 members of the general population aged 18 to 84 years in three regions of France found a prevalence of 12.4% in women and 1.2% of men. It is possibly more common in those with a history of Raynaud phenomenon and chilblains, however is not associated with smoking.

What causes Achenbach syndrome?

Achenbach syndrome is a subcutaneous bruise probably due to minor fragility of capillaries or a small vein in the palmar skin. Preceding minor trauma may be recalled in 30% of cases such as sweeping, handwashing of clothing, or cycling.

There is no associated serious cause for easy bruising such as a clotting disorder or vascular abnormality.

What are the clinical features of Achenbach syndrome? 

Achenbach syndrome characteristically follows minor trauma, although this is often not recalled.

  • Acute onset of pain followed minutes to hours later by discolouration, usually blue-purple.
  • Palmar aspect of the dominant hand is the most common site.
  • Second and third finger involvement is commonest, although any finger, toe, or palmar site can be affected.
  • Sparing of the fingertip and nail bed is characteristic.
  • Discolouration resolves spontaneously in 3–6 days (range 2–14 days), without going through the colour changes usually seen with a resolving bruise.
  • Other — swelling; itch, burning or numbness; involvement of the dorsal digit; limited movement.
  • Normal findings — radial and ulnar pulses; skin perfusion; skin temperature; nail bed capillaroscopy.

Achenbach syndrome of the palms

How do clinical features vary in differing types of skin?

Achenbach syndrome has been reported in Caucasians and Asians. The discolouration may be less obvious in skin of colour.

What are the complications of Achenbach syndrome?


How is Achenbach syndrome diagnosed?

Achenbach syndrome is diagnosed clinically on the typical history and clinical presentation. Many patients have undergone exhaustive investigations for clotting disorders and ischaemic events, all of which are normal/negative.

What is the differential diagnosis for Achenbach syndrome?

  • Bruising due to clotting disorders or low platelet count
  • Capillary fragility due to vitamin C deficiency or amyloidosis
  • Vascular ischaemic events such as embolism or vascular spasm

What is the treatment for Achenbach syndrome?

General measures

There is no specific treatment.

What is the outcome for Achenbach syndrome?

Achenbach syndrome is a benign condition with spontaneous resolution of lesions without sequelae. Episodes can recur with minor trauma, with an average frequency of recurrences of 1.2 per year.



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