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October 2007

Resolution of Chronic Pain and Fingertip Ulceration Due to Hand-Arm Vibration Syndrome Following Combination Pharmacotherapy

Arch Dermatol. 2007;143(10):1331-1344. doi:10.1001/archderm.143.10.1343

Hand-arm vibration syndrome (HAVS) is a well-recognized cause of secondary Raynaud phenomenon. We report a percussionist with vibration-induced peripheral vasospasm and nonhealing fingertip ulceration that responded to combination therapy with pentoxifylline, extended-release nifedipine, and low-dose aspirin.

A 49-year-old white homeless man presented with an 8-month history of severe bilateral fingertip pain. He regularly awoke at night with cold fingers and pins-and-needles pain radiating up his left arm. The patient played conga drums for 4 years, averaging 1 to 2 hours, occasionally up to 5 hours daily. He had a 10 pack-year smoking history. Various treatment failures at outside facilities included cephalexin and trimethoprim/sulfamethoxazole double strength, acetaminophen/hydrocodone, topical 2% nitroglycerin ointment, and naproxen. Hand radiographs revealed preserved bone mineralization, no evidence of fracture or dislocation, and no significant soft tissue swelling.