Idiopathic phalangeal osteolysis

The acro-osteolytic diseases are a heterogeneous group of bone disorders characterized by bone resorption. Acquired and genetic forms have been well described. As hand abnormalities are frequently encountered in dermatologic practice, bone resorptive states, with particular reference to the idiopathic osteolytic disorders, are discussed.

Asymptomatic terminal phalangeal osteolysis has been investigated in two unrelated young adults with no other bony or systemic abnormalities. The nails of the attenuated bulbous fingers were dystrophic, and pigmentary changes were present in the affected areas. The skin was otherwise normal, and there was minimal soft-tissue loss. Roentgenograms of the hands and feet showed varying stages of phalangeal osteolysis.

Both cases represent primary idiopathic acro-osteolysis, as the bony changes are limited to the distal phalanges of the hands and feet. There were no features in the history or clinical evaluation to support a diagnosis of secondary acro-osteolysis.