Ainhum Clinical Presentation

  • Author: Samuel T Selden; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Aug 16, 2011
 

History

Cole[5] has described 4 clinical stages of ainhum.

  • In the first stage, a small clavus or callus develops on the medial aspect of the plantar fold of a toe (usually the fifth) that progresses to a narrow groove or fissure. This groove deepens and slowly encircles the toe. Progression may be slow and can develop first in childhood. The deepening of the fissure is associated with pain in 78% of patients but is less intense than pain in the third stage.
  • The second stage is shorter because the toe becomes globular distal to the groove, which is associated with arterial narrowing and bone resorption.
  • In the third stage, the bone separates at the joint with hypermotility of the toe. Pain may be intense.
  • The fourth stage is characterized by a bloodless autoamputation of the toe at the site of the encircling band.
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Physical

The clinical presentation depends on the stage to which the ainhum has progressed.

  • The initial sign of a painful fissure under a toe may not be defining, but the progressive constriction at the base of the toe with distal edema is diagnostic of ainhum.
  • The toe may become rotated, clawed, and dorsiflexed at the metatarsophalangeal joint.
  • Ultimately, before the toe is shed, it may be attached by an increasingly slender thread of fibrous tissue.
  • The clinical, histologic, and radiographic appearances in pseudoainhum are similar or identical to true ainhum.
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Causes

In 1952, Wells and Robinson[6] proposed 4 distinct sources of annular constrictions of the digits. The sources include (1) annular scarring from frostbite, burns, or trauma, (2) true ainhum, (3) constricting bands that simulate ainhum, and (4) congenital bands.

The exact etiology of true ainhum is unclear. Race and climate apparently are predisposing factors. Ainhum also may have a genetic component, since ainhum has been reported to occur within families. Infection and walking barefoot in childhood are linked to ainhum but probably are not major factors in its development. Abnormal scarring does not appear to be a cause; ainhum and keloid formation rarely occur in the same individual.

Pseudoainhum may be acquired or congenital.

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Contributor Information and Disclosures
Author

Samuel T Selden  MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Samuel T Selden is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Smeena Khan, MD  Private Practice, Adult and Pediatric Dermatology Associates

Smeena Khan, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD  Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Greene JT, Fincher RM. Case report: ainhum (spontaneous dactylolysis) in a 65-year-old American black man. Am J Med Sci. Feb 1992;303(2):118-20. [Medline].

  2. Mendelson DS, Chan KF, Song IS. Spontaneous dactylolysis with pain in a 58-year-old American Black man. JAMA. Oct 2 1981;246(14):1591-2. [Medline].

  3. da Silva Lima JF. On ainhum. Arch Dermatol. 1880;6:367.

  4. Olivieri I, Piccirillo A, Scarano E, Ricciuti F, Padula A, Molfese V. Dactylolysis spontanea or ainhum involving the big toe. J Rheumatol. Dec 2005;32(12):2437-9. [Medline].

  5. Cole GJ. Ainhum: An account of fifty-four patients with special reference to etiology and treatment. J Bone Joint Surg Br. Feb 1965;47:43-51. [Medline].

  6. Wells TL, Robinson RC. Annular constrictions of the digits. AMA Arch Derm Syphilol. Nov 1952;66(5):569-72. [Medline].

  7. Cunliffe WJ. Ainhum and pseudo-ainhum. In: Rook A, Wilkinson DS, Ebling FJ. Textbook of Dermatology. Vol 2. Oxford: Blackwell Scientific; 1979:1638.

  8. Demis DJ. Ainhum, pseudoainhum, and tourniquet syndrome. In: Demis DJ, Dobson RL, McGuire J. Clinical Dermatology. 7th ed. Hagerstown, Md: Harper & Row; 1979:4-47.

  9. Mallory SB. An Illustrated Dictionary of Dermatologic Syndromes. New York, NY: The Parthenon Publishing Group; 1994:Appendix.

  10. Castori M, Valiante M, Ritelli M, et al. Palmoplantar keratoderma, pseudo-ainhum, and universal atrichia: A new patient and review of the palmoplantar keratoderma-congenital alopecia syndrome. Am J Med Genet A. Aug 2010;152A(8):2043-7. [Medline].

  11. Bassetto F, Tiengo C, Sferrazza R, Belloni-Fortina A, Alaibac M. Vohwinkel syndrome: treatment of pseudo-ainhum. Int J Dermatol. Jan 2010;49(1):79-82. [Medline].

  12. Fetterman LE, Hardy R, Lehrer H. The clinico-roentgenologic features of ainhum. Am J Roentgenol Radium Ther Nucl Med. Jul 1967;100(3):512-22. [Medline].

  13. Jemmott T, Foster AV, Edmonds ME. An unusual cause of ulceration: ainhum (dactylolysis spontanea). Int Wound J. Sep 2007;4(3):251-4. [Medline].

  14. Rossiter JW, Anderson PC. Ainhum: treatment with intralesional steroids. Int J Dermatol. Jun 1976;15(5):379-82. [Medline].

  15. Allyn B, Leider M. Dactylolysis spontanea (ainhum). Report of a case treated by the surgical procedure known as Z-plasty. JAMA. May 25 1963;184:655-7. [Medline].

  16. Browne SG. Ainhum. Int J Dermatol. Jun 1976;15(5):348-50. [Medline].

  17. Dent DM, Fataar S, Rose AG. Ainhum and angiodysplasia. Lancet. Aug 22 1981;2(8243):396-7. [Medline].

  18. Hunt M, Glucksman EE. Ainhum presenting to the accident and emergency department. Arch Emerg Med. Dec 1993;10(4):324-7. [Medline].

  19. Kean BH, Tucker HA, Miller WC. Ainhum: a clinical summary of forty-five cases on the Isthmus of Panama. Trans R Soc Trop Med Hyg. 1946;39:331-4.

  20. Ramesh V, Misra RS, Mahaur BS. Pseudoainhum in porokeratosis of Mibelli. Cutis. Feb 1992;49(2):129-30. [Medline].

  21. Schulz EJ. Genodermatoses. Dermatol Clin. Oct 1994;12(4):787-96. [Medline].

  22. Sharma RC, Sharma AK, Sharma NL. Pseudo-ainhum in discoid lupus erythematosus. J Dermatol. Apr 1998;25(4):275-6. [Medline].

 
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Ainhum of the finger. Courtesy of Hon Pak, MD, and reviewed by Ross Levy, MD.
 
 
 
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