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Early changes of acroosteolysis can be detected by x-ray. In this radiograph there is dissolution and fragmentation of the bone in several of the terminal phalanges.~CDC

Acroosteolysis is resorption of the distal bony phalanges. Acroosteolysis has two patterns of resorption in adults: diffuse and bandlike.

The diffuse pattern of resorption has a widely diverse differential diagnosis which includes: pyknodysostosis, collagen vascular disease and vasculitis, Raynaud's neuropathy, trauma, epidermolysis bullosa, psoriasis, frostbite, sarcoidosis, hypertrophic osteoarthropathy, acromegaly, and advanced leprosy.[1][2][3]

The bandlike pattern of resorption may be seen with polyvinyl chloride exposure and Hadju-Cheney syndrome.[1]

Hand shows an acro-osteolysis of the distal phalange

A mnemonic commonly used for acro-osteolysis is PINCHFO.[4] Pyknodysostosis, Psoriasis, Injury (thermal burn, frostbite), Neuropathy (diabetes), Collagen vascular disease (scleroderma, Raynaud's), Hyperparathyroidism, Familial (Hadju-Cheney, progeria), Occupational (polyvinyl exposure),

Acroosteolysis may be associated with minimal skin changes or with ischemic skin lesions that may result in digital necrosis.[5]: 665 

See also


  1. 1.0 1.1 Yu, Joseph. Musculoskeletal Imaging, Case Review Series. 2008.
  2. Romero, Belinchón; Ramos Rincón, J.M.; Reyes Rabellc, F. "Nail Involvement in Leprosy". ACTAS Dermo-Sifiliograficas. Academia Española de Dermatología y Veneralogía. Archived from the original on 28 April 2015. Retrieved 28 June 2014.
  3. Baran, Robert; de Berker, David A. R.; Holzberg, Mark; Thomas, Luc (July 23, 2012). Baran and Dawber's Diseases of the Nails and their Management (4th ed.). Wiley. ISBN 978-0470657355. Archived from the original on 29 April 2022. Retrieved 28 June 2014.
  4. Archived 2013-03-22 at the Wayback Machine[bare URL]
  5. Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.