Ainhum, a rare mutilating dermatological disease in a female Cameroonian: a case report

Abstract

Background Ainhum is an idiopathic dermatological disease characterized by a progressive constricting ring usually on the fifth toe, which may lead to spontaneous auto-amputation of the affected toe. Timely diagnosis and treatment are the key elements to avert amputations with resultant mutilating deformities, permanent handicaps and psychological sequelae. Though common in African descents, this pathology has not been described in the Cameroonian literature. Herein, we report the case of an adult Cameroonian woman presenting with ainhum. Case presentation A 54-year old Cameroonian was admitted to our primary healthcare centre with a 6-month history of a painful constriction band developing at the base of her right fifth toe. Her past history was uneventful. Based on the absence of trauma and spontaneous onset of the condition, the diagnosis of ainhum was most suggestive. She was managed surgically by excision of the band, disarticulated at right fifth metatarsophalangeal joint and skin closure. Her post-operative course after 1 year was uneventful. Conclusion Here we presented a case of ainhum, a rare dermatological disease with few reports. In view of the serious complications of ainhum such as mutilating deformities with permanent physical disabilities and psychological trauma, we draw clinicians’ attention, especially wound care specialists to this rare but potentially handicapping disease, for timely diagnosis and management.

Ainhum: revisited

“…Ainhum also called as dactylolysis spontanea is derived from the Nago (Brazil) word meaning fissure or Nigerian word meaning ‘to saw or cut’ 1. It is a rare disease chiefly noticed among black Africans and African Americans with male predominance ratio of 2:1 with symmetrical distribution though isolated digits can also be affected 2.…”

Surgical site infection leading to gangrene and amputation after ambulatory surgical care of an ingrown toenail: a case report

“…However, toenail gangrene can also be found when an excessive volume of local anesthetics is injected circumferentially around the toe [8]. In the contemporary literature, very few good-quality studies have shown a correlation between the use of epinephrine as an adjuvant to local anesthesia and the occurrence of toenail gangrene [18, 19]. However, the use of epinephrine should be avoided in patients with peripheral cardiovascular diseases or increased risks of peripheral ischemia such as Raynaud’s syndrome due to the vaso-constricting effects of epinephrine which may aggravate ischemia [20, 21].…”

Dactylolysis spontanea (ainhum)

“…Ainhum is a rare idiopathic, acquired condition symmetrically involving fifth toes in dark‐skinned individuals of African, Asian, Indian and American origins 1 . It presents with a constrictive ring of fibrous tissue leading to spontaneous phalangeal self‐amputation 2 . The diagnosis is based on clinical criteria: soft tissue constriction, bulbous enlargement of toes, thinning or lysis of phalangeal bones and radiological confirmation 3 .…”

“…1 It presents with a constrictive ring of fibrous tissue leading to spontaneous phalangeal self-amputation. 2 The diagnosis is based on clinical criteria: soft tissue constriction, bulbous enlargement of toes, thinning or lysis of phalangeal bones and radiological confirmation. 3 Ainhum should be distinguished by pseudo-ainhum due to trauma, infections (e.g., syphilis, leprosy and yaws), congenital conditions (e.g., Streeter's dysplasia, keratoderma hereditarium mutilans and palmo-plantar keratoderma), and other diseases such as scleroderma, diabetes, vascular gangrene.…”