Untitled Observation | Dermatol Pract Concept 2015;5(3):12 53 DERMATOLOGY PRACTICAL & CONCEPTUAL www.derm101.com The patient A 15-year-old, otherwise healthy boy presented with 2-year- history of swelling and thickening localized to the lateral aspects of his fingers. Dermatological examination revealed fusiform soft tissue swelling on the lateral and medial aspects of the second to fourth proximal interphalangeal (PIP) joints of both hands (Figure 1). There was no arthralgia or limited range of motion. Rheumatological examination was oth- erwise normal. There was no history of repetitive trauma, tick-like habits or any mental disorders. Laboratory tests, including routine biochemistry, thyroid function tests, and rheumatologic markers, disclosed no abnormalities. An MRI and X-ray examination was normal except for soft tissue hypertrophy around the affected joints (Figure 2). What is your diagnosis? Symmetrical fusiform swellings around the proximal interphalangeal joints Merve Hatun Saricam1, Andac Salman2, Ayse Deniz Yucelten3 1 Merve Hatun Saricam, Marmara University, School of Medicine, Department of Dermatology, Istanbul, Turkey 2 Andac Salman, Marmara University, School of Medicine, Department of Dermatology, Istanbul, Turkey 3 Ayse Deniz Yucelten, Marmara University, School of Medicine, Department of Dermatology, Istanbul, Turkey Key words: fibromatosis, pachydermodactyly Citation: Saricam MH, Salman A, Yucelten AD. Symmetrical fusiform swellings around the proximal interphalangeal joints.Dermatol Pract Concept 2015;5(3):12. doi: 10.5826/dpc.0503a12 Received: May 16, 2015; Accepted: June 16, 2015; Published: April 30, 2015 Copyright: ©2015 Saricam et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: None. Competing interests: The authors have no conflicts of interest to disclose. All authors have contributed significantly to this publication. Corresponding author: Andac Salman, MD, Marmara Universitesi Pendik Egitim ve Arastirma Hastanesi, Dermatoloji Anabilim Dali Fevzi Cakmak Mah, Mimar Sinan Cad. No:41, 34899 Pendik, Istanbul, Turkey. Tel. +902166570606, ext 4649; Fax: +902165970052. E-mail: asalmanitf@gmail.com Figure 1. Fusiform, soft tissue swelling on the lateral and medial aspects the proximal interphalangeal joints of the second to fourth fingers. [Copyright: ©2015 Saricam et al.] Figure 2. X-ray examination shows soft tissue swelling around the affected joints without any osseous changes. [Copyright: ©2015 Saricam et al.] 54 Observation | Dermatol Pract Concept 2015;5(3):12 any articular or osseous changes. Ultrasonography also con- firms the presence of soft tissue hypertrophy without hyper- vascularization and the absence of joint disease. Similarly, magnetic resonance imaging (MRI) reveals only soft tissue swelling without synovitis or tendinitis [3]. Though histopat- hology is not routinely necessary in clinical practice, it shows epidermal acanthosis, increase in dermal collagen and mucin deposits in dermis [1-3]. There is no effective treatment for PDD. Avoidance of mechanical trauma may result in improvement. Intralesional corticosteroid injections and localized resection of subcuta- neous tissue were reported to be effective in some cases [2-5]. However, given to its benign nature, non-invasive treatment options are recommended for PDD [2]. In conclusion, recognition of this rare, or under-reported, benign condition is crucial to prevent patients from unneces- sary or expensive laboratory tests and improper treatment with immunosuppresive agents. References 1. Kamino H, Reddy VB, Pui J. Fibrous and fibrohistiocytic prolifera- tions of the skin and tendons. In: Bolognia JL, Jorizzo JL, Schaffer JV, eds. Dermatology. 3rd ed. China: Elsevier, 2012:1961-77. 2. Beltraminelli H, Itin P. Pachydermodactyly—just a sign of emo- tional distress. Eur J Dermatol 2009;19:5-13. 3. Dallos T, Oppl B, Kovacs L, et al. Pachydermodactyly: a review. Curr Rheumatol Rep 2014;16:442-9. 4. Ulusoy H, Tas NP, Akgol G, et al. Unusual unilateral presentation of pachydermodactyly: a case report. Rheumatol Int 2012;32:1747- 50. 5. Bardazzi F, Neri I, Raone B, et al. Pachdermodactyly: seven new cases. Ann Dermatol Venereol 1998;125:247-50. Answer Pachydermodactyly. Clinical course Although a treatment with intralesional corticosteroids was planned, the patient was lost to follow-up. Discussion Pachydermodactyly (PDD), is an uncommon, benign form of superficial digital fibromatosis [1]. It is characterized by asymptomatic, periarticular soft tissue swelling of the PIP joints. The disease is most commonly seen in young, otherwise healthy males [1-3]. While PDD usually affects the PIP joints symmetrically, involvement of distal interphalangeal (DIP) joints and metacarpophalangeal (MCP) joints or unilateral disease can also be seen [4]. In the transgradient form of PDD, both MCP and PIP joints are affected [3]. The etiology of PDD is not fully understood but repetitive minor traumas (occupational, habitual or compulsive) are thought to be the major contributing factor [1,2]. PDD was reported to be associated with obsessive-compulsive disorder, Asperger syndrome, Ehlers-Danlos syndrome and tuberous sclerosis [3]. PDD may resemble juvenile idiopathic arthritis, rheu- matoid arthritis, knuckle pads, pachydermoperiostosis or acromegaly [3]. The diagnosis of PDD is usually made with typical clinical findings. Laboratory tests and radiographic examination may be helpful in exclusion of the differential diagnosis. X-ray imaging shows soft tissue swelling without