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Acro-osteolysis

Changed by Rohit Sharma, 9 Jan 2023

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Disclosures - updated 17 Aug 2022: Nothing to disclose

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Acro-osteolysis (plural: acro-osteolyses), also known as phalangeal osteolysis, refers to resorption of the distal phalanx. The terminal tuft is most commonly affected. It is associated with a heterogeneous group of pathological entities, some of which can be remembered by the mnemonic PINCH FO.

Terminology

There are two main radiological variants of acro-osteolysis ¹⁷:

longitudinal type: terminal tuft resorption
transverse type: linear bone resorption of the midshaft of the distal phalanx: band acro-osteolysis

These variants may coexist ¹⁷.

Pathology

Multiple digits

Terminal tuft resorption

scleroderma ⁴
Raynaud disease
psoriatic arthritis
thermal injury
- extreme cold: frostbite
- extreme heat: burns, electricity
trauma
hyperparathyroidism
epidermolysis bullosa
porphyria
drugs
- phenytoin (occurs in infants of epileptic mothers treated with phenytoin) ⁷
- ergot poisoning/abuse
insensitivity to pain, e.g. leprosy, congenital insensitivity to pain
juvenile idiopathic arthritis
dermatomyositis
vascular occlusion ⁵
reactive arthritis ⁶
pityriasis rubra pilaris ~~(very rare skin condition)~~ ⁸
pachydermoperiostosis ⁹
sarcoidosis ¹⁶

Midshaft resorption (band acro-osteolysis)

polyvinyl chloride exposure ¹⁰
primary acro-osteolysis: Hajdu-Cheney syndrome
hyperparathyroidism (also causes terminal tuft resorption)
scleroderma ¹¹(also causes terminal tuft resorption)
idiopathic non-familial acro-osteolysis ¹⁵
pyknodysostosis ^13,14 (also causes terminal tuft hypoplasia)
biomechanical in guitar players ¹¹

Single digit

~~-<li><a href="/articles/pityriasis-rubra-pilaris">pityriasis rubra pilaris</a> (very rare skin condition) 8</li>~~
+<li><a href="/articles/pityriasis-rubra-pilaris">pityriasis rubra pilaris</a> 8</li>

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