Ainhum Clinical Presentation

  • Author: Samuel T Selden, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Sep 16, 2015
 

History

Criteria for diagnosis involves three conditions: soft tissue constriction, bulbous enlargement of the toes, and thinning or lysis of phalangeal bones. As the condition progresses, confirmation can be made via radiographic imaging.

The four stages of ainhum are as follows:

  • Grade I involving a groove with no swelling visible and no bone involvement
  • Grade II is a bulbous enlargement of the digit distally, resulting in external rotation
  • Grade III consists of osseous involvement
  • Grade IV is the development of autoamputation

 

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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[7] 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.

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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, MD is a member of the following medical societies: American Academy of Dermatology, International Society of Geriatric Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

References
  1. Greene JT, Fincher RM. Case report: ainhum (spontaneous dactylolysis) in a 65-year-old American black man. Am J Med Sci. 1992 Feb. 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. 1981 Oct 2. 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. 2005 Dec. 32(12):2437-9. [Medline].

  5. Priya B, Suganthy RR, Manimegalai M, Krishnaveni A. Familial ainhum: a case report of multiple toe involvement in a father and son, staging of ainhum with insight into different types of constricting bands. Indian J Dermatol. 2015 Jan-Feb. 60 (1):106. [Medline].

  6. de Araujo DB, Lima SM, Giorgi RD, Chahade WH. Ainhum (dactylolysis spontanea): a case with hands and feet involvement. J Clin Rheumatol. 2013 Aug. 19 (5):277-9. [Medline].

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

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

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  12. Dasari BV, McBrearty A, Lau L, Lee B. Pseudoainhum of the toe with underlying chronic lower-limb ischemia. Int J Low Extrem Wounds. 2011 Jun. 10(2):96-7. [Medline].

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

  15. 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. 2010 Aug. 152A(8):2043-7. [Medline].

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

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

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

  19. Kura MM, Parsewar S. Reversal of pseudo-ainhum with acitretin in Camisa's syndrome. Indian J Dermatol Venereol Leprol. 2014 Nov-Dec. 80 (6):572-4. [Medline].

  20. Turan E, Yesilova Y, Kokgil T, Guvenc U. Pseudoainhum in a patient with tuberous sclerosis complex: a case report and review of the literature. Int J Dermatol. 2014 Mar. 53 (3):357-61. [Medline].

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

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