Clinical Example: Conservative treatment of draining gouty tophus
| Gouty arthopathy follows
uric acid crystallization in synovial fluid, usually an acute event.
Uric acid precipitation in soft tissues is more often a slow,
progressive, cumulative process. Occasionally, a gouty tophus may
arise acutely, as in this case. Tophi represent a diffuse interstitial
deposition of uric acid without true margins - similar to dried paint
in a sponge. Symptoms are due to pressure effects, and respond to
decompression. Radical excision is usually not needed, even for large
collections. |
| Click on each image for a larger picture |
| This picture was sent
to the office from a nursing home clinic. The patient had developed
this minimally tender mass over the previous week. |
| One day later, the
precipitation progressed and ruptured into a subepithelial collection. |
| Xrays showed a homogeneous
shadow consistent with a large gouty tophus. |
| This was observed, allowed
to rupture, and managed with dry dressing changes. One week later, the
gouty debris is visible in the open wound. The raised epithelium
and subepidermal components have shed. |
| Another week later (two
weeks after presentation), the wound is nearly healed. No further
treatment is needed beyond medical treatment for gout. |
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