Laboratory Studies

Thyrotropin and growth hormone levels should be examined to exclude thyroid acropachy and acromegaly. Reactive plasma reagent and Venereal Disease Research Laboratory testing should be performed to check for syphilitic periostosis.

Imaging Studies

Radiographs of the long bones reveal subperiosteal new bone formation, which is a characteristic radiologic feature.^[42]This feature is mainly seen in the distal tibia, the fibula, the radius, the ulna, the metacarpals, the phalanges, and, less frequently, the metatarsals. Acro-osteolysis and ossification of the ligaments and interosseus membranes may also occur.^{[43, 44]}

Other radiographic abnormalities include the following^[45]:

Patients may develop cortical thickening without narrowing of the medullary cavity.
Enlargement of the paranasal sinuses is reported.

Radionucleotide bone imaging (bone scanning) findings in patients with pachydermoperiostosis or primary hypertropic osteoarthropathy demonstrate increased radiopharmaceutical uptake in the diaphyses and the metaphyses of long bones along the cortical margins.^{[46, 45]}Uptake may result from hyperemia occurring prior to subperiosteal proliferation. Periarticular regions may also have increased uptake because of associated synovitis. Scintigraphic findings (such as those described above) often precede changes noted on radiographs.^[47]

Bone scan abnormalities, found in 15% of patients, less commonly involve the mandible, the maxilla, the clavicles, the scapulae, and the patellae.

Ultrasound may document echogenic tissue surrounding the long bones; Doppler sonograms may show increased vascularity on the surface of some superficial bony structures.^[42]

Treatment & Management

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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 Workup

Laboratory Studies

Imaging Studies

References

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