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ainhum; bankokeren; dactylolysis spontanea; sukhapakla
autoamputation of a digit, usually of the fifth toe bilaterally
Etiology:
- generally the result of a constricting scar
Epidemiology:
- predominantly occurs in black Africans
Pathology:
- a small callus develops on the medial aspect of the plantar fold of a toe (usually the fifth toe) that progresses to a narrow groove or fissure
- fissuring & epidermal hyperkeratosis, followed fibrosis (collagen/scar tissue) under the deepening fissure
- the groove deepens & slowly encircles the toe
- the toe becomes globular distal to the groove
- as scar tissue contracts, it constricts & narrows neurovascular bundles
- neuropathy, ischemia, bone resorption, autoamputation
Clinical manifestations:
- pain may be intense in later stages (ischemia vs bone pain)
Radiology:
- radiography
Management:
- no treatment appears to alter the course of disease
- in early stages
- salicylic acid ointment
- intralesional steroid injections (20-40 mg/mL triamcinolone acetonide suspension) may reduce pain
General
skin disease (dermatologic disorder, dermatopathy, dermatosis)
vascular disease (vasculopathy)
bone disease; osteopathia
References
- Wikipedia: Ainhum
http://en.wikipedia.org/wiki/Ainhum
- Selden ST and Elston DM
Medscape (eMedicine): Ainhum
http://emedicine.medscape.com/article/1074953-overview