Pachydermoperiostosis Treatment & Management

Updated: May 11, 2019
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may alleviate the polyarthritis associated with pachydermoperiostosis or primary hypertropic osteoarthropathy. Most patients treated with NSAIDs had clinical improvement. [44] Etoricoxib, a selective COX-2 inhibitor not approved for use in the United States, has also be successfully used. [45] Methotrexate may be considered too if there is a large inflammatory component. [46]

Thickened skin on the glabellar region may benefit from botulinum injections. [47]

In isolated cases, pamidronate and tamoxifen citrate have been reported as effective therapies for the painful osteoarthropathy associated with pachydermoperiostosis or primary hypertropic osteoarthropathy. [48, 49, 50, 51]

In a single case report, pachydermoperiostosis or primary hypertropic osteoarthropathy associated arthritis was treated with the combination of oral administration of risedronate sodium and arthroscopic synovectomy. [52]

A study from Shanghai found that etoricoxib, a selective cyclooxygenase-2 inhibitor, may improve the pachydermia, clubbing finger, and joint swelling. [53]

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Surgical Care

Vagotomy may improve the articular pain and swelling associated with pachydermoperiostosis or primary hypertropic osteoarthropathy.

Plastic surgery may improve the appearance of the face and scalp by excising redundant skin and correcting the cutis verticis gyrata. Bilateral blepharoplasties, tarsal wedge resections, excision of skin furrows, and facial rhytidectomy have been described as methods of providing cosmetic improvement. [54, 55, 56]

Surgical correction of the clubbing through bilateral resection and shortening of the nail bed, nail matrix, and soft tissue has been reported. [57]

If anti-inflammatory therapy is insufficient with knee arthritis, arthroscopic synovectomy and radiosynoviorthesis performed consecutively may be an option. [58]

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