ainhum; bankokeren; dactylolysis spontanea; sukhapakla

Introduction

autoamputation of a digit, usually of the fifth toe bilaterally

Etiology

• generally the result of a constricting scar

Epidemiology

• predominantly occurs in black Africans

Pathology

• a small callus develops on the medial aspect of the plantar fold of a toe (usually the fifth toe) that progresses to a narrow groove or fissure
• fissuring & epidermal hyperkeratosis, followed fibrosis (collagen/scar tissue) under the deepening fissure
• the groove deepens & slowly encircles the toe
  • the toe becomes globular distal to the groove
• as scar tissue contracts, it constricts & narrows neurovascular bundles
  • neuropathy, ischemia, bone resorption, autoamputation

Clinical manifestations

• pain may be intense in later stages (ischemia vs bone pain)

Radiology

• radiography

Management

• no treatment appears to alter the course of disease
• in early stages
  • salicylic acid ointment
  • intralesional steroid injections (20-40 mg/mL triamcinolone acetonide suspension) may reduce pain

More general terms

• skin disease (dermatologic disorder, dermatopathy, dermatosis)
• vascular disease (vasculopathy)
• bone disease; osteopathia