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A 42-year-old man presented with gradually progressive thickening of his scalp, face and extremities. He also com-plained of hyperhidrosis of palms and sole. On examina-tion, he had coarse ‘leonine like ’ facies, with thickened folded skin of face, eyelids and scalp with mechanical partial ptosis ( fi gure 1). Scalp examination revealed typi-cal gyrate appearance (cutis verticis gyrate). He had ‘spade like ’ hands and feet. There was moderate clubbing of the fi ngers and toes, but the hands had ‘claw like ’ appearance due to a persistent fl exion of the interphalangeal joints ( fi gures 2 – 4). X-ray of the wrists and ankles revealed a faint radiolucent line beneath the new periosteal bone along the shaft of long bones at their distal ends. X-ray chest and skull were normal. Slit skin smear for leprosy was negative and growth hormone assay was normal. He is the only child of healthy consanguineous parents. Other affected members are not described in this family. All these features are typi-cal of ‘pachydermoperiostosis ’ (PDP). PDP, also known as Touraine–Solente–Gole ’ syndrome, is a genetic disor-der and has an autosomal recessive or dominant (variable expression) inheritance pattern. 1 2 The condition usually begins insidiously at puberty and is characterised by pach-ydermia (thickened skin of face and extremities, thick and corrugated scalp), periostosis (excessive bone formation) and fi nger clubbing. 2 Because of thickness and heaviness of eyelids, mechanical ptosis can occur. This is often known as idiopathic or primary hypertrophic osteoarthropathy t