Unilateral milia-type intradermal tophi associated with underlying urate subcutaneous deposition: an uncommon cutaneous presentation of gout

Abstract

Tophi develop during the most advanced clinical stage of gout, and are usually located on or around the joints. However, unusual skin features caused by intradermal and/or subcutaneous deposition of tophaceous material at locations other than articular regions have been reported. We present the case of a patient with a condition that has been recently termed 'miliarial gout'. which is only the second such case, to our knowledge. A 51-year-old woman, who had a chronic joint disease that had been diagnosed and treated as psoriatic arthritis, presented with multiple asymptomatic, yellowish-white, firm papules (1-3 mm in size) on erythematous areas on the outside of her left leg. On histological examination of a skin biopsy, uric acid crystals were seen in the dermis and subcutis. The patient also had a raised level of serum urate, consistent with a diagnosis of gout. Treatment with allopurinol led to rapid improvement. Intake of corticosteroids and diuretics was a possible triggering factor for the development of cutaneous tophi in this patient.

Multiple Cutaneous Creamy Papules and Nodules: A Case of Miliarial Gout

“…6 Previous reports of miliaria-type cutaneous tophaceous gout suggest that the combination of a xanthine oxidase inhibitor, such as allopurinol, and an antiinflammatory, such as colchicine, can be used to good clinical effect, a result paralleled in our patient. 1,2 …”

Miliarial gout: A rare clinical presentation

“…1 Both diseases can be triggered by gluten overload and gastric surgery. 2 We report a case of dermatitis herpetiformis after mini-gastric bypass surgery with no clinical sign or symptom of celiac disease. Mini-gastric bypass is a modification of the standard Roux-en-Y procedure using a long gastric tube with an antecolic loop gastrojejunostomy.…”

Finger pad tophi in gout: a rare presentation

“…However, unusual skin manifestations caused by intradermal and subcutaneous deposition of tophaceous material at locations other than periarticular regions have been reported. 1-3 …”

“…1-5 Intradermal tophi are rare skin manifestations of chronic gout that are characterized by multiple, tiny, superficial, pustule or milia-like, whitish lesions. 3-5 Rarely they appear at extra-articular sites such as forearms, arms, finger pad, legs, buttock, thigh, penis, vocal cords, epiglottis, tongue and abdominal wall. 1-3 In our patient, the intradermal gout lesions were restricted to the finger pads.…”

“…3-5 Rarely they appear at extra-articular sites such as forearms, arms, finger pad, legs, buttock, thigh, penis, vocal cords, epiglottis, tongue and abdominal wall. 1-3 In our patient, the intradermal gout lesions were restricted to the finger pads. Risk factors predisposing to the development of intradermal gout include renal insufficiency, hypertension, long-term use of furocemid and corticosteroids, long-term duration of disease, obesity, and lack of consistent use of urate-lowering therapy.…”