Kariotis R, Vrtíková E, Hapčová M, Zwerina J, Dallos T
1. Medizinische Abteilung und Ludwig Boltzmann Institut für Osteologie, Hanusch Krankenhaus, Heinrich-Collin Str. 30, 1140, Wien, Österreich.
Z Rheumatol. 2013 Jun;72(5):482-5. doi: 10.1007/s00393-012-1118-1.
The differential diagnosis of swelling of the small finger joints is broad. We report on two young men presenting with progressive painless swelling of the proximal interphalangeal (PIP) joints where the physical examination was otherwise inconspicuous. Laboratory investigations including auto- antibodies were all normal, x-rays and magnetic resonance imaging (MRI) revealed no joint pathologies but only increased skin thickening. Skin biopsy demonstrated hyperkeratosis and acanthosis without tissue inflammation. We thus diagnosed pachydermodactyly in both cases. This rare disease predominantly affects young males, can affect one or both hands and is often associated with mechanical stress due to repetitive movements in patients with obsessive-compulsive disorders. Occupational exposure by monotonous actions (e.g. poultry processing) may also be a cause. A specific therapy is unnecessary in most cases but may include intralesional steroid administration or surgical resection. Cessation of mechanical stress can significantly improve pachydermodactyly.
小指关节肿胀的鉴别诊断范围很广。我们报告了两名年轻男性，他们表现为近端指间关节（PIP）进行性无痛肿胀，而体格检查在其他方面并无明显异常。包括自身抗体在内的实验室检查均正常，X线和磁共振成像（MRI）未显示关节病变，仅显示皮肤增厚增加。皮肤活检显示角化过度和棘层肥厚，无组织炎症。因此，我们诊断这两例均为厚皮性指端皮炎。这种罕见疾病主要影响年轻男性，可累及一只或双手，并且在患有强迫症的患者中，常与重复动作引起的机械性应力有关。单调动作（如家禽加工）的职业暴露也可能是一个原因。大多数情况下无需特殊治疗，但可能包括病灶内注射类固醇或手术切除。停止机械性应力可显著改善厚皮性指端皮炎。
