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His hobbies include practicing martial arts, which includes sessions with a punching bag; he denies playing an instrument or doing any manual labor. If there were associated inflammation and pain of the joints, evaluation for rheumatoid arthritis could be appropriate. Pachydermodactyly is a proliferation of fibrous tissue on the hands. He has seen three other doctors to discuss the changes on his hands. He denies pain or functional limitation. However, it has been reported in patients with Ehlers-Danlos syndrome and patients with tuberous sclerosis.

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He also has hypopigmented papules on the second MCP joint bilaterally Figures 1 and 2.

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You have already added this topic to your email alerts. There is overlying hypopigmentation bilaterally. He denies pain or functional limitation.

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