Tophi Formation on Palmar and Plantar Surfaces in Patients with Chronic Gout

Overview

This report discusses a case of a 47-year-old man with chronic gout presenting with tophi on atypical sites, specifically the palmar and plantar surfaces. The diagnosis was confirmed through clinical examination and serum uric acid levels, emphasizing the need for accurate identification of tophi to avoid misdiagnosis.

Background

Tophi are a hallmark of chronic gout, resulting from the accumulation of monosodium urate crystals due to chronic hyperuricemia. Their formation can lead to significant joint deformities and functional limitations, impacting patients' quality of life. Atypical presentations, such as tophi on palmar and plantar surfaces, are rare and can be mistaken for other skin conditions, complicating diagnosis and management.

Data Highlights

No numerical data or trial data were presented in the source material.

Key Findings

• Tophi can occur in atypical locations, including the palmar and plantar surfaces, which is exceptionally rare.
• Diagnosis of tophi at these sites can be confirmed by needle aspiration showing negatively birefringent monosodium urate crystals.
• Palmar tophi may resemble calcinosis cutis or pyogenic pustules, while plantar tophi can mimic warts or calluses.
• Accurate diagnosis is crucial to avoid unnecessary procedures, as these lesions can be mistaken for infections or malignancies.
• Management of refractory tophaceous disease may include treatments such as pegloticase or febuxostat.

Clinical Implications

Clinicians should be aware of the possibility of tophi in atypical locations to ensure accurate diagnosis and appropriate management. Resuming urate-lowering therapy, such as allopurinol, is essential for preventing further tophi formation and managing gout effectively.

Conclusion

The identification of tophi on palmar and plantar surfaces highlights the need for vigilance in diagnosing gout in atypical presentations. Proper management is critical to mitigate the complications associated with chronic gout.

Related Resources & Content

1. Frontiers in Immunology, 2026 -- From uric acid to tophi: multistage molecular and cellular mechanisms of tophi formation
2. Clinical Rheumatology, 2021 -- Nasal Bone Erosion Associated with Gouty Tophus Formation
3. Frontiers in Immunology, 2026 -- Neutrophil extracellular traps in gout: from immune defense to pathological dynamic equilibrium
4. Clinical Rheumatology, 2011 -- A Review of Gouty Arthritis Pathophysiology and Its Clinical Management Strategies
5. 2020 American College of Rheumatology Guideline for the Management of Gout
6. Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial - PubMed
7. Palmar and Plantar Tophi in Chronic Gout | Journal of General Internal Medicine | Springer Nature Link
8. 2020 American College of Rheumatology Guideline for the Management of Gout
9. Long-term cardiovascular safety of febuxostat compared with allopurinol in patients with gout (FAST): a multicentre, prospective, randomised, open-label, non-inferiority trial - PubMed
10. Palmar and Plantar Tophi in Chronic Gout | Journal of General Internal Medicine | Springer Nature Link