Tuesday, May 29, 2012

Digital Pitting from Scleroderma

Scleroderma is a wicked disease.  The disease first robs patients of their well-being, then their dignity, and finally their health and perhaps their life.  The picture we see above is a harbinger of future problems.  These pits, which are classically found on the fingerpads, are part of the diagnostic criteria for systemic scleroderma.  Those criteria are as follows:

Major criterion:
1. Sclerodermatous change proximal to the MCPs.

Minor criteria:
1. Sclerodactyly
2. Digital pitted scars of fingertips or loss of substance of the finger pads
3. Bibasilar pulmonary fibrosis

In order for the diagnosis to be made, the patient must fulfill either the major criterion, or two of the minor criteria.

Raynaud's Phenomenon, nail fold capillary changes, eosinophilic fasciitis, and nephrogenic systemic fibrosis can also be part of the syndrome, along with myriad other changes that involve virtually every organ system in advanced cases.

The pitting associated with Gorlin's Syndrome are far more subtle, and usually more numerous.  The various disorders in keratinization usually result in a much higher number, and more dramatic individual presentation.  Plus, I gave you the clue that you should have surmised it was part of a syndrome.

If you named an associated feature of scleroderma, I gave you credit for each non-redundant one that was reasonable.  A few of you really cleaned up on this one.  Nice work.

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