Pachydermodactyly Successfully Treated With Triamcinolone Injections

Teenage boy with thickened dorsal hands and feet

“…Tuberous sclerosis will have other clinical findings. Knuckle pads present on the dorsal surface of the skin overlying the joint, in contrast to PDD, which occurs on the lateral aspects of the digits, although there have been cases of PDD and knuckle pads occurring together . Some even suggest that PDD may be a forme fruste of knuckle pads .…”

“…PPD can present with joint pain and as such can be confused with an inflammatory arthropathy. The pathogenesis is largely unknown, although it is thought to be related to mechanical friction, including frequent rubbing, stretching, and cracking of the fingers and hobbies and occupations such as weightlifting and martial arts . There have been correlations of cases with several psychiatric diseases, including obsessive‐compulsive disorder, Asperger syndrome, attention deficit hyperactivity disorder, mental retardation, and Tourette syndrome.…”

“…Cessation of the mechanical friction may prevent disease progression, and pharmacologic control of any underlying psychiatric condition may help eliminate mechanical friction. There have been reports of surgical excision and triamcinolone injections to affected areas, with some effect . Given the broad differential diagnosis, it is important to identify PDD to avoid treating patients with other agents unnecessarily.…”

Pachydermodactyly: Case report including clinical and histopathologic diagnostic pitfalls

“…The etiology is not fully understood but is believed to be due to excessive mechanical manipulation of PIP joint periarticular skin, such as from tic‐like joint rubbing . It has been associated with occupational and athletic activities, “obsessive” keyboard and computer game use, generalized anxiety disorder, obsessive‐compulsive disorder, and Asperger syndrome . Rare cases are familial .…”

“…For mild cases, cessation of repetitive trauma can lead to gradual resolution, and thus some patients may benefit from behavioral modification and counseling. Intralesional triamcinolone or surgical excision may be performed on patients with severe deformity and functional impairment.…”