Dactylolysis spontanea (ainhum)

Ainhum is a rare idiopathic, acquired condition symmetrically involving fifth toes in dark-skinned individuals of African, Asian, Indian and American origins.1 It presents with a constrictive ring of fibrous tissue leading to spontaneous phalangeal self-amputation.2 The diagnosis is based on clinical criteria: soft tissue constriction, bulbous enlargement of toes, thinning or lysis of phalangeal bones and radiological confirmation.3 Ainhum should be distinguished by pseudo-ainhum due to trauma, infections (e.g., syphilis, leprosy and yaws), congenital conditions (e.g., Streeter's dysplasia, keratoderma hereditarium mutilans and palmo-plantar keratoderma), and other diseases such as scleroderma, diabetes, vascular gangrene.4 A 43-year-old woman from Burkina Faso came to our department with a 10-year history of a painful, ulcerated, constrictive band involving her right fifth toe. Previous treatments with antibiotics and dressings led to no significant improvement. She was otherwise healthy and had no family history of similar conditions. On examination, the right fifth toe appeared to be clanged by a fibrous band (Figure 1). Distal pulses were present, and no regional lymph node enlargements were found. Signs of neuropathy or palmo-plantar hyperkeratosis were not observed. Radiological imaging showed no bone involvement. The patient was referred to orthopaedics and underwent amputation of her right fifth toe and osteotomy of the distal fifth metatarsal with complete pain relief. Serena Bergamo and Alessandro Gatti contributed to the collection of data and management of the patient. Serena Bergamo wrote the initial draft of the manuscript. Alessandro Gatti revised the manuscript and prepared the final version. All authors have read and approved the final manuscript and agree to take full responsibility for the integrity and accuracy of the work. The authors declare no conflict of interest. All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable. Data sharing is not applicable to this article as no data sets were generated or analysed during the current study.