To the Editor:

We thank Dr. Wollina for his interest in our clinical image. Our patient did not undergo a biopsy of the affected skin; the condition was identified based on clinical appearance alone. The histologic appearance of pachydermodactyly that was outlined in our report was a brief review of descriptions of such in the literature and was consistent with descriptions of this condition in major dermatology textbooks (Weedon D. Pachydermodactyly. In: Weedon D, editor. Skin pathology. 2nd ed. Edinburgh: Churchill Livingstone; 2002. p. 923). We appreciate Dr. Wollina's suggestion that our patient may actually have had chewing pads, which, like pachydermodactyly, are thought to derive from repetitive trauma. Unlike pachydermodactyly, however, chewing pads are usually found on the dorsum of the knuckles rather than the radial and ulnar aspects of the knuckle, as was the case with our patient. It may be that the difference between the 2 clinical entities is simply the site of the trauma. Either way, it is important that rheumatologists be aware of both entities in order to avoid unnecessary investigations.

J. D. Akikusa MD*, M. Weinstein MD*, R. M. Laxer MD, FRCP*, * Hospital for Sick Children, Toronto, Ontario, Canada.