title: Unilateral milia-type intradermal tophi associated with underlying urate subcutaneous deposition: an uncommon cutaneous presentation of gout.
abstract: Tophi develop during the most advanced clinical stage of gout, and are usually located on or around the joints. However, unusual skin features caused by intradermal and/or subcutaneous deposition of tophaceous material at locations other than articular regions have been reported. We present the case of a patient with a condition that has been recently termed 'miliarial gout'. which is only the second such case, to our knowledge. A 51-year-old woman, who had a chronic joint disease that had been diagnosed and treated as psoriatic arthritis, presented with multiple asymptomatic, yellowish-white, firm papules (1-3 mm in size) on erythematous areas on the outside of her left leg. On histological examination of a skin biopsy, uric acid crystals were seen in the dermis and subcutis. The patient also had a raised level of serum urate, consistent with a diagnosis of gout. Treatment with allopurinol led to rapid improvement. Intake of corticosteroids and diuretics was a possible triggering factor for the development of cutaneous tophi in this patient.
authors.affiliation: Department of Dermatology, University of Lleida, Lleida, Catalonia, Spain.
authors.forename: R S
authors.initials: RS
authors.lastname: Aguayo
authors.forename: M
authors.initials: M
authors.lastname: Baradad
authors.forename: X
authors.initials: X
authors.lastname: Soria
authors.forename: L
authors.initials: L
authors.lastname: Abal
authors.forename: V
authors.initials: V
authors.lastname: Sanmartín
authors.forename: R
authors.initials: R
authors.lastname: Egido
authors.forename: P
authors.initials: P
authors.lastname: Gallel
authors.forename: J M
authors.initials: JM
authors.lastname: Casanova
authors.forename: R M
authors.initials: RM
authors.lastname: Martí
mesh_terms: D015210:Arthritis, Gouty / Q000150:complications*; D015535:Arthritis, Psoriatic / Q000150:complications*; D005260:Female; D006801:Humans; D007866:Leg; D008875:Middle Aged; D012871:Skin Diseases / Q000209:etiology*; D014527:Uric Acid / Q000378:metabolism*
chemical_list: D014527:Uric Acid