# Pachydermodactyly: An Uncommon Benign Digital Disorder

## TL;DR

This paper presents a rare case of pachydermodactyly in a teenage girl, emphasizing its underrecognition and the importance of proper diagnosis to avoid unnecessary treatments.

## Contribution

The paper contributes a clinical case highlighting pachydermodactyly's underrecognition in females and successful conservative treatment.

## Key findings

- Pachydermodactyly was correctly diagnosed in a 14-year-old girl with finger swelling and no inflammatory signs.
- Treatment with triamcinolone acetate led to significant reduction in swelling.
- The case underscores the need for awareness to prevent misdiagnosis as inflammatory arthropathies.

## Abstract

Pachydermodactyly is a rare, benign, and non-inflammatory digital fibromatosis, typically presenting in adolescents with painless and progressive swelling of the soft tissues around the proximal interphalangeal (PIP) joints. Most often observed in young males, it is frequently linked to repetitive mechanical behaviors such as finger rubbing, clasping, or habitual trauma. Despite its benign nature and preserved joint function, the condition is often mistaken for inflammatory arthropathies, leading to misdiagnosis and potentially inappropriate management.

We describe the case of a 14-year-old girl with no prior medical history, referred to the Physical and Rehabilitation Medicine from the pediatric department due to a six-month history of finger swelling. The initial concern arose from her family physician, and she denied any pain, trauma, or systemic symptoms. However, she had been taking piano lessons since the age of six. There was no family history of rheumatologic disease. On physical examination, bilateral fusiform swelling of the second and third fingers was observed, centered at the proximal phalanges. The patient had the full range of motion and was pain-free on palpation. Laboratory investigations and radiographs were unremarkable. Given the typical clinical features and absence of inflammatory or structural abnormalities, a diagnosis of pachydermodactyly was made. Treatment consisted of a local infiltration of triamcinolone acetate, which was well tolerated and led to a significant reduction in swelling at follow-up.

We report this case to raise awareness of pachydermodactyly as a rare but important differential diagnosis in adolescents presenting with finger swelling. The condition is frequently underrecognized, particularly in women, and can be mistaken for inflammatory or autoimmune diseases. Early identification can prevent unnecessary investigations and treatments. This case also highlights a positive response to conservative interventional management, supporting individualized care based on clinical presentation and patient preferences.