Progressive tickening of the fingers in a teenager

Abstract

An 18-year-old male with no personal or family history of disease presented with progressive widening of the fingers, a condition that had been evolving for nine years. Patient history revealed the use of a video game console five months prior to the onset of the clinical condition. Dermatological examination showed soft-tissue enlargement on the lateral aspects of the proximal phalanges of the second, third, and fourth digits of both hands (Photo 1). Laboratory tests were ordered to rule out rheumatological and thyroid diseases, yielding no pathological findings; radiographs of both hands revealed increased soft-tissue thickness at the proximal phalanges of the affected digits, with no bone or joint abnormalities (Photo 2). A skin biopsy was performed on the lateral aspect of the third digit of the left hand for histopathological analysis; the report indicated hyperplastic epidermis with a psoriasiform pattern, hyperkeratosis, and orthokeratosis. Dense, thickened collagen was observed in the dermis (Photo 3), and Alcian Blue staining revealed mucin deposition within the dermis (Photo 4).