eMedicine Specialties > Dermatology > Diseases of the Dermis

Ainhum: Differential Diagnoses & Workup

Author: Samuel Selden, MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School
Contributor Information and Disclosures

Updated: Mar 13, 2009

Differential Diagnoses

Leprosy
Syphilis
Lupus Erythematosus, Discoid
Yaws
Morphea
Pityriasis Rubra Pilaris
Porokeratosis

Other Problems to Be Considered

Congenital constricting bands of infants and young children
Trauma (burns, frostbite, ergot poisoning, tourniquet syndrome)
Connective tissue disease (scleroderma, morphea, Raynaud disease, discoid lupus erythematosus)
Infection (syphilis, Hansen disease)
Keratodermas (keratoderma hereditarium mutilans, mal de Meleda, focal acral hyperkeratosis, porokeratosis of Mibelli)
Pityriasis rubra pilaris
Pachyonychia congenita
Endocrine (diabetes mellitus)

Ainhum

Initial fissuring beneath toes may be mistaken for trauma or infection. Dermatophytosis complex may be a complication. In the tropics, where most true ainhum occurs, Hansen disease, syphilis, yaws, and tuberculosis must be excluded. Radiographically, osteolytic lesions may be observed both after trauma and in ainhum.

Following dactylolysis, ainhum may be confused with traumatic amputations, limb aplasia or hyperplasia, diabetic or vascular gangrene, or tourniquet syndrome (from human hair).

Pseudoainhum7,8

Pseudoainhum most commonly is associated with scleroderma, Hansen disease, syringomyelia, and atypical keratoderma. Pseudoainhum refers to congenital annular bands or constrictions resulting from trauma or linked to other diseases.

Congenital bands usually constrict an extremity, but may encircle any portion of the body, and result from congenital collagen dysplasia and not from scarring. The bands frequently are associated with other congenital or developmental anomalies.

Workup

Imaging Studies

  • The radiographic manifestations of ainhum are diagnostic.9,10
    • Initially, a radiolucent band can be observed constricting the base of the involved toe, with distal swelling.
    • Osteolysis develops in the distal and middle phalanges, with a characteristic tapering effect.
    • Ultimately, the bone narrows until it fractures and autoamputates.
  • The radiographic appearances in pseudoainhum are similar or identical to true ainhum.

Histologic Findings

Histologically, ainhum shows fissuring and epidermal hyperkeratosis and parakeratosis, which is followed by a fibrotic reaction under the deepening fissure. The fibrosis is predominately composed of collagen. As scar tissue contracts, it constricts and narrows neurovascular bundles. Histologic appearances in pseudoainhum are similar or identical to those observed in true ainhum.

More on Ainhum

Overview: Ainhum
Differential Diagnoses & Workup: Ainhum
Treatment & Medication: Ainhum
Follow-up: Ainhum
Multimedia: Ainhum
References
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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. 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].

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

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

  12. 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].

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

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

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

  16. 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.

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

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

  19. 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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Further Reading

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Keywords

ainhum, dactylolysis spontanea, bankokerend, sukhapakla, autoamputation of a digit, pseudoainhum, pseudo-ainhum, annular constriction of a digit

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Contributor Information and Disclosures

Author

Samuel Selden, MD, Assistant Professor, Department of Dermatology, Eastern Virginia Medical School
Samuel Selden, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Astellas Pharma US, Inc. Honoraria Consulting; Galderma Laboratories, L.P. Honoraria Review panel membership

Medical Editor

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.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University 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.

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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