Case and Research Letters
Pachydermodactyly in a Patient With Generalized Anxiety Disorder and Tics
Paquidermodactilia en un paciente con trastorno de ansiedad generalizada asociado a tics
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Carrascosa, A. Godoy, C. Gordillo, D. de Argila" "autores" => array:4 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Carrascosa" "email" => array:1 [ 0 => "rachel170786@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Godoy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Gordillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "D." "apellidos" => "de Argila" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital Universitario La Princesa, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Paquidermodactilia en un paciente con trastorno de ansiedad generalizada asociado a tics" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 706 "Ancho" => 1036 "Tamanyo" => 110031 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bilateral symmetric swelling of the lateral surface of the proximal interphalangeal joints of the second, third, fourth, and fifth fingers of both hands.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Pachydermodactyly is a rare, benign form of acquired digital fibromatosis that mainly affects male adolescents without a family history.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is characterized by asymptomatic bilateral symmetric swelling of the lateral aspects of the proximal interphalangeal (PIP) joints of the second, third, fourth, and occasionally fifth fingers.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Although diagnosis is essentially clinical, skin biopsy shows compact orthokeratotic hyperkeratosis, increased numbers of collagen fibers and fibroblasts, and no inflammatory changes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Blood and imaging tests are normal.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 19-year-old man with no past personal or family history of interest who presented with asymptomatic swelling of the PIP joints. The swelling had appeared 2 to 3 years earlier and had initially affected the lateral surfaces of the joints of the fifth finger of the left hand. Similar changes gradually appeared on the PIP joints of the second, third, fourth, and fifth fingers of both hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). During the interview, the patient reported that he often interlocked the fingers of his hands. The physical examination revealed multiple tics involving the face, the trunk, and both arms. The blood results were normal and tests for antinuclear antibodies and rheumatoid factor were negative. Radiography of both hands and nuclear magnetic resonance imaging showed thickening of the soft tissues around the PIP joints on the second through fifth fingers of both hands, with no evidence of bone or joint abnormalities. The only abnormal finding in the bone scan was dorsolumbar scoliosis, with asymmetry in the right coxofemoral joint in relation to the scoliosis. Skin biopsy showed nonspecific lesions that nonetheless were compatible with pachydermodactyly (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We requested psychiatric evaluation and the patient was diagnosed with generalized anxiety disorder associated with tics. Anxiety disorder group therapy at the psychiatry department was recommended. The patient's skin lesions have remained stable to date.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The etiology of pachydermodactyly is unknown, although several authors have suggested that the disorder could be caused by repetitive minor trauma involving the repeated rubbing of fingers during continuous interlocking movements.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> This would explain why pachydermodactyly does not affect thumbs and involves fifth fingers less frequently.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> We saw our patient repeatedly interlocking his fingers during consultation and his mother confirmed that he had being doing this for years. Minor traumas of this nature have been associated with activities such as climbing,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> occupational exposure (poultry processing),<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and underlying psychiatric disorders. There have been reports of pachydermodactyly associated with serious psychiatric disorders, such as obsessive-compulsive disorder, related disorders such as Asperger syndrome or tic disorders, and behavior disorders, such as anxiety disorders.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,6</span></a> Our patient was diagnosed with generalized anxiety disorder associated with tics. He did not fulfil the diagnostic criteria for obsessive-compulsive disorder or Asperger syndrome.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Pachydermodactyly is probably more common than believed and is likely to be underdiagnosed because it is asymptomatic and does not interfere with joint movement. Effective medical interventions do not exist for pachydermodactyly, but triamcinolone hexacetonide injections<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and surgical resection of subcutaneous fibrotic tissue have produced good cosmetic results in some cases.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Rapid clinical diagnosis is important as it will reassure patients and avoid unnecessary tests and studies and inappropriate treatment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">While the association between pachydermodactyly and psychiatric morbidity is uncommon, given its importance, we believe that all patients diagnosed with pachydermodactyly should be evaluated by a psychiatrist, and particularly those who repeatedly interlock or rub their hands, causing finger friction. These patients would benefit from adequate psychological and/or psychiatric treatment, and partial remission of pachydermodactyly lesions has been reported following the elimination of the causes of repetitive minor trauma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Carrascosa R, Godoy A, Gordillo C, de Argila D. Paquidermodactilia en un paciente con trastorno de ansiedad generalizada asociado a tics. Actas Dermosifiliogr. 2014;105:625–626.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 706 "Ancho" => 1036 "Tamanyo" => 110031 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Bilateral symmetric swelling of the lateral surface of the proximal interphalangeal joints of the second, third, fourth, and fifth fingers of both hands.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 774 "Ancho" => 1033 "Tamanyo" => 229715 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histological examination showed a thickened dermis with thickened collagen bundles and increased numbers of fibroblasts, without inflammation. The epidermis showed orthokeratotic hyperkeratosis (hematoxylin-eosin, original magnification ×5). The inset on the right shows the collagen bundles and fibroblasts at higher magnification (hematoxylin-eosin original magnification ×20).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pachydermodactyly: A rare form of acquired digital fibromatosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A.M. Morales Callaghan" 1 => "C. Horndler Argarate" 2 => "F.J. García Latasa de Araníbar" 3 => "M.L. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 6 | 12 | 18 |
| 2024 Octubre | 69 | 36 | 105 |
| 2024 Septiembre | 76 | 36 | 112 |
| 2024 Agosto | 110 | 54 | 164 |
| 2024 Julio | 100 | 36 | 136 |
| 2024 Junio | 111 | 42 | 153 |
| 2024 Mayo | 81 | 43 | 124 |
| 2024 Abril | 77 | 27 | 104 |
| 2024 Marzo | 111 | 30 | 141 |
| 2024 Febrero | 79 | 36 | 115 |
| 2024 Enero | 64 | 34 | 98 |
| 2023 Diciembre | 66 | 20 | 86 |
| 2023 Noviembre | 63 | 22 | 85 |
| 2023 Octubre | 58 | 17 | 75 |
| 2023 Septiembre | 76 | 26 | 102 |
| 2023 Agosto | 52 | 20 | 72 |
| 2023 Julio | 101 | 45 | 146 |
| 2023 Junio | 83 | 27 | 110 |
| 2023 Mayo | 68 | 19 | 87 |
| 2023 Abril | 76 | 30 | 106 |
| 2023 Marzo | 57 | 24 | 81 |
| 2023 Febrero | 53 | 20 | 73 |
| 2023 Enero | 57 | 36 | 93 |
| 2022 Diciembre | 59 | 39 | 98 |
| 2022 Noviembre | 30 | 24 | 54 |
| 2022 Octubre | 30 | 22 | 52 |
| 2022 Septiembre | 30 | 45 | 75 |
| 2022 Agosto | 31 | 37 | 68 |
| 2022 Julio | 28 | 40 | 68 |
| 2022 Junio | 32 | 27 | 59 |
| 2022 Mayo | 37 | 39 | 76 |
| 2022 Abril | 52 | 35 | 87 |
| 2022 Marzo | 52 | 45 | 97 |
| 2022 Febrero | 40 | 34 | 74 |
| 2022 Enero | 70 | 33 | 103 |
| 2021 Diciembre | 38 | 39 | 77 |
| 2021 Noviembre | 51 | 41 | 92 |
| 2021 Octubre | 70 | 46 | 116 |
| 2021 Septiembre | 50 | 47 | 97 |
| 2021 Agosto | 62 | 20 | 82 |
| 2021 Julio | 51 | 29 | 80 |
| 2021 Junio | 26 | 39 | 65 |
| 2021 Mayo | 25 | 47 | 72 |
| 2021 Abril | 64 | 61 | 125 |
| 2021 Marzo | 57 | 28 | 85 |
| 2021 Febrero | 60 | 44 | 104 |
| 2021 Enero | 19 | 15 | 34 |
| 2020 Diciembre | 15 | 14 | 29 |
| 2020 Noviembre | 19 | 15 | 34 |
| 2020 Octubre | 23 | 16 | 39 |
| 2020 Septiembre | 24 | 16 | 40 |
| 2020 Agosto | 21 | 19 | 40 |
| 2020 Julio | 23 | 9 | 32 |
| 2020 Junio | 24 | 20 | 44 |
| 2020 Mayo | 17 | 16 | 33 |
| 2020 Abril | 22 | 14 | 36 |
| 2020 Marzo | 17 | 10 | 27 |
| 2020 Febrero | 3 | 1 | 4 |
| 2019 Diciembre | 4 | 3 | 7 |
| 2019 Noviembre | 0 | 3 | 3 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 5 | 9 |
| 2019 Julio | 0 | 4 | 4 |
| 2019 Junio | 2 | 2 | 4 |
| 2019 Mayo | 1 | 13 | 14 |
| 2019 Abril | 0 | 3 | 3 |
| 2019 Marzo | 2 | 4 | 6 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 4 | 0 | 4 |
| 2018 Septiembre | 2 | 0 | 2 |
| 2018 Febrero | 35 | 3 | 38 |
| 2018 Enero | 34 | 3 | 37 |
| 2017 Diciembre | 45 | 6 | 51 |
| 2017 Noviembre | 40 | 3 | 43 |
| 2017 Octubre | 32 | 3 | 35 |
| 2017 Septiembre | 34 | 7 | 41 |
| 2017 Agosto | 50 | 5 | 55 |
| 2017 Julio | 47 | 6 | 53 |
| 2017 Junio | 56 | 4 | 60 |
| 2017 Mayo | 64 | 9 | 73 |
| 2017 Abril | 46 | 5 | 51 |
| 2017 Marzo | 49 | 4 | 53 |
| 2017 Febrero | 46 | 4 | 50 |
| 2017 Enero | 27 | 5 | 32 |
| 2016 Diciembre | 36 | 17 | 53 |
| 2016 Noviembre | 53 | 12 | 65 |
| 2016 Octubre | 49 | 9 | 58 |
| 2016 Septiembre | 43 | 13 | 56 |
| 2016 Agosto | 41 | 4 | 45 |
| 2016 Julio | 28 | 3 | 31 |
| 2016 Junio | 10 | 3 | 13 |
| 2016 Mayo | 11 | 1 | 12 |
| 2016 Abril | 6 | 23 | 29 |
| 2016 Marzo | 10 | 9 | 19 |
| 2016 Febrero | 7 | 1 | 8 |
| 2016 Enero | 17 | 6 | 23 |
| 2015 Diciembre | 12 | 1 | 13 |
| 2015 Noviembre | 8 | 0 | 8 |
| 2015 Octubre | 10 | 1 | 11 |
| 2015 Septiembre | 5 | 1 | 6 |
| 2015 Agosto | 9 | 1 | 10 |
| 2015 Julio | 34 | 4 | 38 |
| 2015 Junio | 32 | 5 | 37 |
| 2015 Mayo | 35 | 7 | 42 |
| 2015 Abril | 10 | 1 | 11 |
| 2015 Marzo | 18 | 1 | 19 |
| 2015 Febrero | 24 | 6 | 30 |
| 2015 Enero | 20 | 4 | 24 |
| 2014 Diciembre | 22 | 6 | 28 |
| 2014 Noviembre | 14 | 2 | 16 |
| 2014 Octubre | 12 | 2 | 14 |
| 2014 Septiembre | 0 | 1 | 1 |
| 2014 Agosto | 4 | 2 | 6 |
| 2014 Julio | 0 | 2 | 2 |
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