Acrolysis in pachydermoperiostosis. Primary or idiopathic hypertrophic osteoarthropathy

A 45-year-old black woman was admitted for correction of an equinus deformity of the right lower extremity that resulted from shortening of the Achilles tendon. She exhibited classic findings of pachydermoperiostosis, including clubbing of the digits, periosteal new bone formation, and hypertrophy of skin and its adnexa, associated with several facial acne. In addition, she showed excessive resorption of distal phalanges of the hands and feet, a finding heretofore unreported in pachydermoperiostosis, to our knowledge. Reduced peripheral blood flow has been observed in patients with pachydermoperiostosis; the resorption of distal phalanges observed in our patient may have resulted from this mechanism.