Paroxysmal finger hematoma (PFH), also known as paroxysmal hand hematoma, painful blue finger, or Achenbach's syndrome, is an uncommon skin condition characterized by spontaneous bleeding into the second, third, or fourth fingers, which results in pain, tingling, and/or itching in the finger followed by discoloration and swelling. The cause of paroxysmal finger hematoma is unknown, but it is considered benign and non-urgent as it resolves on its own without treatment over an average of four days.
Causes It is not known what causes PFH. Many patients report no injury to the finger before symptoms start, and no genetic, environmental, or lifestyle link has been identified. Women get PFD more often than men, and most people who report PFD are over the age of 40. PFH can recur in the same patient.
Signs and symptoms PFD has a sudden onset of between 24-48 hours. The first symptom to appear is a sudden pain, tingling, or itching, followed by bruising and swelling. The bruising can sometimes appear bluish, thus mimicking cyanosis despite adequate perfusion to the digit.
Diagnosis PFH is diagnosed after all differential diagnoses are ruled out. Some differential diagnoses include:
Acute limb ischemia Raynaud syndrome Thromboangiitis obliterans (Buerger disease) Acrocyanosis Painful bruising syndrome (Gardner-Diamond syndrome) Acrorygosis Chilblains Deep vein thrombosis of the finger Unlike in the above conditions, PFH presents with unaltered pulses and temperatures of the affected finger. Vascular imaging studies like Doppler ultrasonography, CT angiography, and echocardiograms show regular functioning. Analyses of blood cells, coagulation studies, and immunological assays also show no problems. Additioanlly PFH frequently (but not always) appears on only the palmar aspect of one or two digits, as opposed to other conditions where additional digits, the entire hand, or multiple extremities may be affected. In PFH, the tip of the finger usually remains unaffected. Lack of provider knowledge about PFH increases patient anxiety, unnecessary referrals and hospital admissions, and invasive diagnostic tests.
Treatment Because PFH always resolves on its own, treatment is focused on reducing pain with mild, over-the-counter painkillers. The person presenting with PFH may be alarmed by the sudden onset and abnormal presentation of the affected finger, and therefore benefits from assurance of its benign and self-resolving nature.
See also List of cutaneous conditions Hematoma Phalanx bone
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