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Authors: Dr Dushyanth Gnanappiragasam, Dermatology Specialist Registrar; Dr Karen Harman, Consultant Dermatologist, University Hospitals of Leicester NHS Trust, United Kingdom. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. January 2020.
Pachydermodactyly is a form of benign digital fibromatosis which causes progressive asymptomatic periarticular thickening, most commonly around the proximal interphalangeal joints. Some subtypes may have palmar and metacarpophalangeal (MCP) joint involvement.
Pachydermodactyly most commonly occurs in adolescents and young men. The affected male to female ratio is 4:1 [1,2].
The exact cause of pachydermodactyly is not fully understood. It has been linked to repetitive mechanical stimulation in genetically predisposed individuals. Hormonal factors may also have an influence as illustrated by the predominance in male individuals and symptoms appearing at the age of puberty.
Common triggers identified have been habits such as interlacing, stretching, rubbing and cracking of the fingers, and increased mechanical irritation related to professional sporting and musical activities.
The pathophysiology is thought to be due to deposition of abnormal collagen in the dermis, especially loose strands of type III and type V collagen.
Pachydermodactyly is usually painless. Thickening around the 2nd and to 4th proximal interphalangeal (PIP) joints is most frequently seen. Some patients may also have overlying hyperkeratosis, lichenification, and hyperpigmentation.
Other conditions that may be considered in the differential of diagnosis of pachydermodactyly include:
The diagnosis of pachydermodactyly is largely clinical.
Patients are often investigated to rule out inflammatory arthropathies with:
Features seen in skin biopsies include [1,3]:
Inflammation is typically absent.
Pachydermodactyly may reverse or resolve with cessation of mechanical stimulation if any.
Intralesional corticosteroid (triamcinolone) and surgical resection have been trialled in severe cases with some benefit.
Overall, pachydermodactyly remains stable. Permanent joint deformities or damage are rarely observed.
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