Pachydermodactyly is an uncommon, progressive, nontender thickening of the fingers with prominent involvement of the proximal interphalangeal joints. Pachydermodactyly mimics inflammatory arthritis but plain film radiography is normal in this condition. Pachydermodactyly has been previously described in workers performing manual labor. Mechanical stimulation has been identified as a predisposing factor in the majority of cases. We present three cases in adolescent males arising in association with excessive computer gaming.
A 15-year-old healthy female presented to our dermatology clinic with a 1 year history of recurrent, painful erosions of the nasal and oral mucosa, crusted erosions of the perioral skin, and violaceous macules on her hands. The eruption recurred every month just prior to the onset of her menstrual cycle and lasted for 1 week before healing spontaneously. She denied any history of genital ulcerations. She took no daily medications and was otherwise well. Review of systems was negative. Previous treatments included ketoconazole 2% cream and tacrolimus 0.1% ointment; both of which were ineffective. Examination revealed oral aphthous erosions on the inner labial mucosa, hyperpigmented, crusted plaques involving the bilateral oral commissures and medial cheeks (Figure 1), and targetoid, violaceous papules on the left dorsal index finger (Figure 2) and left dorsal hand. Viral and bacterial cultures were negative from the ulceration and the cutaneous crusted plaques, respectively. Complete blood count (CBC) and iron panel were normal. A punch biopsy was performed (Figures 3-5).
Post-surgical pyoderma gangrenosum is rare. On average it develops 10 days after a surgical procedure. This timeframe is similar to post-operative wound infections, including post-operative necrotizing fasciitis. Consequently, post-surgical pyoderma gangrenosum is frequently misdiagnosed as an infection, leading to detrimental surgical debridement, unnecessary antibiotic use, and delay of proper treatment. We review a case of pyoderma gangrenosum of the right inguinal crease following percutaneous coronary catheterization and review of the literature.
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