INTRADERMAL URATE TOPHI

Objective, To analyze the clinical features and identify risk factors associated with the development of intradermal urate tophi. Methods, S ix patients (5 men and 1 woman, mean age 59.8 yrs) with intradermal to phi were studied between 1987 and 1996. Results, Intradermal urate cry stal deposits appeared as small, superficial, pustule-like, whitish le sions. All patients experienced superimposed inflammatory episodes wit h increasing pain, swelling, and erythema of the intradermal tophi. In one patient, the lesions were associated with a peculiar skin hyperpi gmentation. Five had intermittent liquefaction and ulcerations of the lesions with drainage of white chalky matter from which monosodium ura te crystals were recovered. Mean pre-treatment serum urate was 570.6 m u mol/l (range 496-720). Risk factors for gout and intradermal tophi i ncluded renal failure in all 6, hypertension and chronic diuretic ther apy in 4, and one patient each with alcohol abuse, chronic low dose ac etylsalicylic acid, myeloma, and a positive family history. Conclusion , Intradermal urate tophi with superimposed inflammatory episodes, int ermittent ulcerations, and possibly pigmentary changes, are rare shin manifestations of chronic tophaceous gout. Renal insufficiency, hypert ension, and chronic diuretic use are factors associated with the devel opment of hyperuricemia and gout in these patients.