Search

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.

A 60-year-old man presented with a non-healing interdigital ulcer on the right foot. Various treatment regimens had no effect. Three months later, histopathological examination of a biopsy showed an acrolentiginous amelanotic melanoma. Partial foot amputation followed, but metastases were diagnosed several months later. If no improvement occurs in a benign-looking acral lesion, doctors should closely observe the lesion and consider biopsy.

Background: Besides the natal cleft, a pilonidal sinus can also occur in other areas of the body. An uncommon place is the interdigital web space of the toes. A sinus can arise due to penetration of the skin by a hair. The only curative treatment is surgical excision., Case Description: A 55-year-old man was referred by the GP with an inflammation between his toes. On physical examination we saw a skin defect with hairs and granulation tissue between the fourth and fifth toes of the right foot. It was decided to surgically excise the affected area. Histopathological examination showed a chronical, fibrosing inflammation surrounding a free hair structure, consistent with a pilonidal sinus. The lesion was probably caused by dog hairs, in combination with poor personal hygiene., Conclusion: This patient had a pilonidal sinus at an uncommon site. In the event of poorly-understood inflammation between the toes, a pilonidal sinus should be considered.

A 4-year-old boy was referred because of pan-digital clubbing and watch-glass nails. Other remarkable findings were: surgical closure of a patent arterial duct, decreased knee-mobility and consanguineous parents. This combination is suggestive for primary hypertrophic osteoarthropathy (PHO; #OMIM 259100). PHO was proven by his homozygous mutation of the 15-hydroxyprostaglandine dehydroxygenase-gene.

A 10-year-old boy consulted a dermatologist with a painful, subungual tumour on one of his toes. X-ray showed an outgrowth of the distal phalanx and histopathological investigation showed osteochondromatous proliferation. The patient was diagnosed with exostosis. Subungual exostoses are benign osteocartilaginous tumours that occur beneath the nail bed. Excision was performed, the patient recovered well.

A 64-year-old woman visited the surgeon because of an infected right hallux. After investigation we concluded she had myiasis caused by an infestation with Lucilia Sericata. This usually occurs in tropical regions in patients with low standards of hygiene, but is sometimes found in non-tropical countries, in patients with minor underlying lesions.

A 2-week-old boy, born after an uncomplicated pregnancy of consanguineous parents, was seen with congenital absence of all nails on fingers and toes. After 6 weeks marginal nail growth was seen. Because there were no other congenital abnormalities, this was considered to be anonychia congenita; probably caused by a recessive defect of the R-spondin 4-coding gene.

An 81-year-old woman presented with a subungual pigmented lesion of the left hallux, caused by a malignant acral-lentiginous melanoma.

Three patients, two women aged 66 and 43 years, respectively, and a man aged 76 years, presented with sudden, painful, blue areas in the toes with intact peripheral pulsations. One patient had a myeloproliferative syndrome due to essential thrombocytosis, the second patient had thromboangiitis obliterans, and the third patient had a cholesterol embolism, possibly due to the use of oral anticoagulants. After treatment, one patient recovered fully and the other two improved significantly. The blue toe syndrome is the pathophysiological consequence of end-arterial occlusion and frequently the first manifestation of a systemic disorder, such as atheroembolism or vasculitis. Adequate treatment is possible in most cases. Therefore, it is very important to recognise this disorder and its possible causes so as to prevent further episodes of local symptoms and especially systemic complications.

A 4-month-old male infant had a red and swollen left fourth toe due to strangulation by a hair.

An 18-year-old man had lifelong mucocutaneous lesions from which Candida albicans was persistently cultured. Upon fluconazole treatment the lesions diminished notably.