Management of ulcerated finger pad tophi

Abstract

Finger pad tophi are an unusual but not very rare presentation of uncontrolled gout. Unlike tophaceous lesions of other locations, finger pad tophi are often difficult to diagnose at presentation due to resemblance to a variety of nodular lesions, coexistence with other connective tissue disorders and sometimes occurrence in asymptomatic hyperuricemia. They also pose a therapeutic dilemma due to a lack of clear treatment guidelines. Several case reports of finger pad tophi have been published before, focusing mainly on diagnosis and medical management. We discuss here a case of thumb pad tophi as primary presentation of undiagnosed asymptomatic hyperuricemia and treated surgically with excision and full-thickness skin graft along with urate-lowering therapy. This article highlights the diagnosis and treatment of finger pad tophi. We also discuss the surgical management of tophaceous lesions of hands and digits.

Keywords: finger pad tophi; full-thickness skin graft; surgical treatment; ulcerated.

Fig. 1

Finger pad tophi with ulceration.

Fig. 2

T1- and T2-weighted MRI showing a hypointense lesion in the subcutaneous plane.

Fig. 3

Excision of the lesion. The lesion is noted firmly incorporated within the soft tissue (A); excised tissue (B); the remaining soft tissue bed studded with fine residual crystals (C); full-thickness skin graft coverage (D).

Fig. 4

Six month follow-up showing well-settled graft and full functional recovery.