Disappearing digit: A rare appearance

A 78-year-old man presented with chronic dermatitis of the right little toe for which he was prescribed topical betamethasone 0.05% cream for two weeks but was lost to follow-up. One and a half years later, he presented after applying the same topical once daily under occlusion for nine months. Examination revealed ulceration and shiny atrophy of the right little toe likened to a sharpened pencil [Figure 1]. Peripheral pulses were palpable and no neurological deficit was noted. Radiological examination revealed the distal portion of the right little toe to be resorbed and osteopenic with visualisation of the proximal stump [Figure 2]. No other metabolic or biochemical abnormalities were detected. Based on these clinical findings, a diagnosis of disappearing digit secondary to prolonged topical steroid usage was made.

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Figure 1:

Ulceration and shiny atrophy of the right little toe likened to a sharpened pencil

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Figure 2:

X-ray of the right foot showing the distal portion of the fifth toe to be resorbed and osteopenic with visualisation of the proximal stump

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Disappearing digit is an uncommon presentation of digital atrophy with bone resorption due to prolonged application of high potency topical corticosteroids. Topical steroids are prone to be misused.

Only few cases of disappearing digit following long-term topical steroid application have been reported in the past.^1,2 Disappearing digit has also been described as a part of metabolic bone disease in end-stage renal disease where it was attributed to a markedly elevated parathormone level which resulted in bone resorption.³

Steroid abuse is a commonly encountered problem but its consequence ‘disappearing digit’ is not so common. A clinical picture as such should alert the physician about drug misuse.