PACHYDERMOPERIOSTOSIS (idiopathic hypertrophic osteoarthropathy) is characterized by digital clubbing, periosteal bone changes, furrowing of the skin, and sebaceous gland overactivity.1 The fully developed case is easily recognized if there is an awareness of this entity. Milder cases in which only the musculoskeletal features are prominent are frequently unrecognized or are misdiagnosed as a form of secondary hypertrophic osteoarthropathy. While certainly not a common entity, our recent experience suggests that a failure to recognize this condition is partially to blame for its supposed rarity.
Pachydermoperiostosis is probably most frequently confused with that variety of secondary hypertrophic osteoarthropathy seen in association with certain malignant tumors, especially bronchogenic carcinoma. Because of the usually grave prognostic implications of hypertrophic osteoarthropathy, the physician must view this finding with great concern. However, in order to prevent undue mental anguish in those patients who present with hypertrophic osteoarthropathy and in whom no obvious cause can