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Pachydermoperiostosis
Disease definition
Pachydermoperiostosis (PDP) is a form of primary hypertrophic osteoarthropathy (see this term), a rare hereditary disorder, and is characterized by digital clubbing, pachydermia and subperiosteal new bone formation associated with pain, polyarthritis, cutis verticis gyrata, seborrhea and hyperhidrosis. Three forms have been described: a complete form with pachydermia and periostitis, an incomplete form with evidence of bone abnormalities but lacking pachydermia, and a forme frusta with prominent pachydermia and minimal-to-absent skeletal changes.
ORPHA:2796
Classification level: DisorderSummary
Epidemiology
The prevalence is unknown. PDP occurs predominantly in men (male to female ratio: 7:1) and the disease is more severe in men than in women.
Clinical description
PDP typically begins during childhood or adolescence and may stabilize after 5-20 years of progression, or progress constantly. However, in the neonatal period, late closure of the fontanels and a patent arterial duct (see this term) may be observed. PDP presents with digital clubbing and dermatological (pachydermia, thickening and furrowing of the facial features, cutis verticis gyrata, seborrhea, edema, hyperhidrosis) and rheumatological symptoms (joint effusion, arthritis, acro-osteolysis, periosteal ossification). Patients may develop severe kyphosis, restricted motion and neurological manifestations. PDP may also be associated with congenital heart disease, particularly patent arterial duct.
Etiology
Mutations in the HPGD gene (4q33-q34) have been identified. The gene encodes 15-hydroxyprostaglandin dehydrogenase (15-PGDH), the main enzyme of prostaglandin degradation. Patients with homozygous mutations have chronically elevated prostaglandin E2 levels.
Diagnostic methods
Diagnosis is based on clinical signs, X-ray exam, magnetic resonance imaging (MRI) and/or radionucleotide bone imaging showing typical bone abnormalities, such as diaphyseal periostosis and acro-osteolysis.
Differential diagnosis
Differential diagnoses include cranio-osteoarthropathy (see this term), secondary hypertrophic osteoarthropathy, chronic recurrent multifocal osteomyelitis, SAPHO and Camurati-Engelman disease (see these terms), thyroid acropachy and syphilitic periostosis.
Genetic counseling
PDP is inherited as an autosomal recessive trait; however, heterozygous carriers can have a mild phenotype. Genetic counseling should be offered to patients and their families.
Management and treatment
Rheumatologic symptoms can be improved by nonsteroidal anti-inflammatory drugs, corticosteroids or colchicine. Clinical improvement of the dermatological symptoms is achieved by retinoids. Plastic surgery may be helpful for facial involvement. Surgical reduction of finger clubbing has been performed with success.
Prognosis
PDP may progress constantly, leaving patients with chronic debilitating complications, such as clubbing and arthritis.
A summary on this disease is available in Deutsch (2011) Español (2011) Français (2011) Italiano (2011) Nederlands (2011) Português (2011) Greek (2011, pdf)
Additional information