Paroxysmal finger haematoma - a benign acrosyndrome occurring in middle-aged women

Abstract

Summary:Background: Paroxysmal fi nger haematoma (PFH) is an under-recognised vascular acrosyndrome with no epidemiological description to date. The aim of this work was to evaluate the prevalence, risk factors and clinical correlates of PFH in a population-based sample of subjects and to describe their semiological characteristics. Patients and methods: This cross-sectional study of random samples of the general population in three geographic areas of France involved 802 subjects, 548 women and 254 men, aged 18 to 84 years. The diagnosis of PFH was made from a report by the subject of a history of recurrent haematoma in the fi ngers with a sudden, painful and unexpected occurrence. Diagnosis of associated conditions and evaluation of lifestyle variables were obtained through standardised medical interview and examination. Results: A history of PFH was detected in 71 subjects, with a prevalence of 1.2 % in men and 12.4 % in women; there was no signifi cant regional variation. Onset before 40 years of age was rare. Besides female sex and age, no socio-economical nor lifestyle risk factors were detected. PFH was associated with Raynaud phenomenon and a history of chilblains, but no link with any health threatening disease was found. In addition to the sudden onset of pain and hematoma, the main clinical features were a frequent digital swelling during the painful attack, and their predominant location on the volar side of the fi rst and second phalanges of the third or second fi ngers of the dominant hand. Conclusions: PFH is a benign phenomenon, frequently found in middle-aged women, to be classifi ed among the vascular acrosyndromes. Patients seeking medical evaluation for this disorder should be reassured.

ESVM guidelines – the diagnosis and management of Raynaud’s phenomenon

“…The syndrome mostly aff ects women in the fourth to sixth decades. Frequently, another vascular primary acrosyndrome coexists [12] (acrocyanosis, chilblains, primary RP).…”

Paroxysmal acral haematoma is a more appropriate name for Achenbach syndrome

“…This self‐limiting condition presents as spontaneous focal haemorrhage into the palm or the volar surface of a finger, which may result in transitory localized pain, followed by rapid swelling and localized bluish discolouration . Although only around 100 cases have been published to date, the condition actually seems to be more common, with the prevalence reported as 12.4% in women (only 1.2% in men) in the general population, according to a French study based on a medical interview . Most dermatology textbooks and review papers mention only hands and fingers as the affected sites .…”

“…Although only around 100 cases have been published to date, the condition actually seems to be more common, with the prevalence reported as 12.4% in women (only 1.2% in men) in the general population, according to a French study based on a medical interview . Most dermatology textbooks and review papers mention only hands and fingers as the affected sites . However, Dr Cohen in the recent correspondence article on the syndrome wrote: ‘It mostly occurs over the finger joints, but the thumb and toes can also be affected’ .…”

Hematoma digital espontaneo, síndrome de Achenbach

“…El síndrome de Achenbach continúa siendo una entidad desconocida, con pocos reportes en la literatura; una revisión sistemática llevada a cabo en 2 016 identificó 12 reportes de caso a nivel mundial concluyendo que la media de edad de presentación fue a los 49.5 años, de predominio en mujeres (91% de los casos), asociado a dolor y edema en el 58% de los pacientes y parestesias/ prurito en el 25% (3) . De igual manera, en un estudio retrospectivo, evaluaron a 24 pacientes de mediana edad diagnosticados con síndrome de Achenbach, concluyendo que la localización más frecuente fue en el dedo índice de la mano derecha, asociado a dolor intenso, pero, sin hallazgos anormales en los exámenes de laboratorio (4)(5)(6) . Coincidiendo con el lugar de presentación y la tendencia a la normalidad en los laboratorios de la paciente presentada en este manuscrito.…”