Diagnostic Considerations

Rosenfeld-Kloepfer syndrome, a variant of pachydermoperiostosis or primary hypertropic osteoarthropathy, is characterized by enlargement of the mandible and/or the maxilla; large hands, feet, nose, lips, and tongue; prominence of the upper part of the forehead; cutis verticis gyrata; and corneal leukoma.

Currarino idiopathic osteoarthropathy is a juvenile incomplete form of pachydermoperiostosis or primary hypertropic osteoarthropathy characterized by eczema and wide cranial sutures.^[40]

A variant form of pachydermoperiostosis or primary hypertropic osteoarthropathy restricted to the lower extremities in the absence of digital clubbing or typical skin changes has been described. It affected 3 members of a single family and was characterized by pain, swelling, and hyperhidrosis of both feet. Radiographs revealed bony changes consistent with pachydermoperiostosis or primary hypertropic osteoarthropathy.^[41]

Secondary hypertrophic pulmonary osteoarthropathy must be excluded.

Thyroid acropachy may cause diagnostic confusion. Unlike pachydermoperiostosis or primary hypertropic osteoarthropathy, thyroid acropachy is not painful.

Syphilitic periostosis can result in bony changes and symptoms similar to those seen in pachydermoperiostosis or primary hypertropic osteoarthropathy.

Differential Diagnoses

Gigantism and Acromegaly

Workup

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Media Gallery

Clubbed fingernail.
Cutis verticis gyrata. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/dermal-infiltrative/cvg2.jpg).

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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Coauthor(s)

Supriya Goyal, MD Consulting Dermatologist

Supriya Goyal, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Gregory M Richards, MD Clinical Assistant Professor, Department of Human Oncology, University of Wisconsin School of Medicine and Public Health

Gregory M Richards, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Medical Association, American Roentgen Ray Society, American Society for Radiation Oncology, Radiological Society of North America, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Rajiv Goyal, MD Radiologist, Department of Radiology, Kaiser Permanente Medical Center

Rajiv Goyal, MD is a member of the following medical societies: American Medical Association, MedChi The Maryland State Medical Society, Radiological Society of North America, Maryland State Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Pachydermoperiostosis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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