[A woman with a white skin lesion of her toe]

A 78-year-old woman visited her general practitioner with a sharply bounded white lesion of her toe. We diagnosed it as gouty tophus, which was confirmed by a high serum urate level. Gout is a chronic disease, characterised by deposition of monosodium urate crystals in joints and tissues. The preferable sites of gouty tophi are fingers, toes, knees, elbows, conchae and heels. Treatment of acute gout consists of NSAIDs, steroids or colchicine. Gouty tophi require lifelong urate-lowering treatment.