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Digital exostosis causing enlargement of the fingertip
132
Journal of the American Academy of Dermatology
Correspondence
Comment. Although not diagnostic of lupus panniculitis, these histologic findings reflect, in our opinion, the underlying connective tissue disease with a superimposed picture of typical erythema nodosum. Hyalin fat necrosis, a feature seen in panniculitis of several connective tissue diseases 2 as well as in the connective tissue panniculitis, 3 may modify histologic features otherwise typical of panniculitides such as erythema nodosum, and at the same time it may be a helpful clue to the clinical background of a connective tissue disorder.
Krzysztof Dabski, M.D., and R. K. Winkelmann, M.D., Ph.D. Mayo Clinic and Mayo Foundation Rochester, M N 55905
REFERENCES 1. Winkelmann RK, Forstrom L. New observations in the histopathology of erythema nodosum. J Invest Dermatol 1975;65:441-6. 2. Winkelmann RK. Pannieulitis in connective tissue disease. Arch Dermatol 1983;119:336-44. 3. Winkelmann RK, Padilha-Goncalves A. Connective tissue panniculitis. Arch Dermatol 1980;116:291-4.
Digital exostosis causing enlargement of the fingertip To the Editor: Subungual exostosis is a well-recognized clinical entity) Exostoses arising from the ventral aspect of the distal phalanx, however, appear to be very unusual. Case
report. A 40-year-old woman gave a 20-year history
of gradual enlargement of the pulp of the left index finger.* The pulp had become very painful and the patient was tending to oppose the thumb to the middle instead of the index finger. Examination revealed swelling of the pulp that on palpation was very hard. The presence of an underlying exostosis arising from the ventral aspect of the distal phalanx was confirmed radiologically (Fig. 1). No other exostoses could be found on physical examination. The exostosis was removed surgically. Comment. Expansion of the fingertip may be caused by benign and malignant tumors of bone or soft tissue. Exostoses with which dermatologists are familiar invariably arise from the dorsal aspect of the distal phalanx of the hallux 2 or, less commonly, the thumb .or index finger? They do not cause generalized enlargement of the finger pulp but are first seen as firm, tender lesions around the nail. Exostoses may arise elsewhere on the hand, In a series of 376 exostoses, 4 7 arose on the finger, *No specific traumatic incident could be recalled that might have predated the onset of the problem.
Fig. 1. Radiograph of the left index finger showing a ventral exostosis and overlying soft tissue swelling.
although the exact site was not stated. Most of the lesions were of a sessile type with a broad base that differs from the exostosis described, which has a narrow base and a slightly expanded tip. This case is unusual in the site of the origin of the exostosis and the manner of presentation. Dermatologists should be aware that exostoses may first appear in sites other than in the usual subungual position.
M. P. James, B.Sc., M.B., M.R.C.P. Royal Berkshire Hospital London Road, Reading, Berks. RGI 5AN, United Kingdom
REFERENCES I. Norton LA. Nail disorders. J AM ACAD DERMATOL 1980;2:451-67. 2. Evison GE, Price CHG. Subungual exostosis. Br J Radiol 1966;39:451-5. 3. Matthewson MH. Subungual exostosis of the fingers: are they really uncommon? Br J Dermatol 1978;98:187-9. 4. Mangini U. Tumors of the skeleton of the hand. Bull Hosp Joint Dis 1967;28:61-103.
Journal of the American Academy of Dermatology
Correspondence
Comment. Although not diagnostic of lupus panniculitis, these histologic findings reflect, in our opinion, the underlying connective tissue disease with a superimposed picture of typical erythema nodosum. Hyalin fat necrosis, a feature seen in panniculitis of several connective tissue diseases 2 as well as in the connective tissue panniculitis, 3 may modify histologic features otherwise typical of panniculitides such as erythema nodosum, and at the same time it may be a helpful clue to the clinical background of a connective tissue disorder.
Krzysztof Dabski, M.D., and R. K. Winkelmann, M.D., Ph.D. Mayo Clinic and Mayo Foundation Rochester, M N 55905
REFERENCES 1. Winkelmann RK, Forstrom L. New observations in the histopathology of erythema nodosum. J Invest Dermatol 1975;65:441-6. 2. Winkelmann RK. Pannieulitis in connective tissue disease. Arch Dermatol 1983;119:336-44. 3. Winkelmann RK, Padilha-Goncalves A. Connective tissue panniculitis. Arch Dermatol 1980;116:291-4.
Digital exostosis causing enlargement of the fingertip To the Editor: Subungual exostosis is a well-recognized clinical entity) Exostoses arising from the ventral aspect of the distal phalanx, however, appear to be very unusual. Case
report. A 40-year-old woman gave a 20-year history
of gradual enlargement of the pulp of the left index finger.* The pulp had become very painful and the patient was tending to oppose the thumb to the middle instead of the index finger. Examination revealed swelling of the pulp that on palpation was very hard. The presence of an underlying exostosis arising from the ventral aspect of the distal phalanx was confirmed radiologically (Fig. 1). No other exostoses could be found on physical examination. The exostosis was removed surgically. Comment. Expansion of the fingertip may be caused by benign and malignant tumors of bone or soft tissue. Exostoses with which dermatologists are familiar invariably arise from the dorsal aspect of the distal phalanx of the hallux 2 or, less commonly, the thumb .or index finger? They do not cause generalized enlargement of the finger pulp but are first seen as firm, tender lesions around the nail. Exostoses may arise elsewhere on the hand, In a series of 376 exostoses, 4 7 arose on the finger, *No specific traumatic incident could be recalled that might have predated the onset of the problem.
Fig. 1. Radiograph of the left index finger showing a ventral exostosis and overlying soft tissue swelling.
although the exact site was not stated. Most of the lesions were of a sessile type with a broad base that differs from the exostosis described, which has a narrow base and a slightly expanded tip. This case is unusual in the site of the origin of the exostosis and the manner of presentation. Dermatologists should be aware that exostoses may first appear in sites other than in the usual subungual position.
M. P. James, B.Sc., M.B., M.R.C.P. Royal Berkshire Hospital London Road, Reading, Berks. RGI 5AN, United Kingdom
REFERENCES I. Norton LA. Nail disorders. J AM ACAD DERMATOL 1980;2:451-67. 2. Evison GE, Price CHG. Subungual exostosis. Br J Radiol 1966;39:451-5. 3. Matthewson MH. Subungual exostosis of the fingers: are they really uncommon? Br J Dermatol 1978;98:187-9. 4. Mangini U. Tumors of the skeleton of the hand. Bull Hosp Joint Dis 1967;28:61-103.