To the Editor.
—I am responding to a report in the Archives (1980;140:1087-1088) by Hedayati et al in which a patient with pachydermoperiostosis and acro-osteolysis was described. Although the authors have indeed documented an unusual phalangeal complication of this disease, I wish to call attention to a previous report by Guyer et al1 in which four of five patients with pachydermoperiostosis demonstrated osteolysis of varying severity. In this latter article, reference is made to additional descriptions that would seem to document acro-osteolysis in cases of pachydermoperiostosis. Although review of my cases of this disease does not disclose an example of such a phalangeal change, I have observed minor irregularities of the tufts and bony spiculation. Similar phalangeal alterations with minor degrees of osteolysis may occasionally be observed in patients with secondary hyperthrophic osteoarthropathy.