DOI: 10.7241/ourd.20122.28                                                                     article in PDF
Our Dermatol Online. 2012; 3(2): 131-133
Date of submission: 07.03.2011 / acceptance: 19.12.2011
Conflicts of interest: None


Patricia Chang

Dermatologist Hospital General de Enfermedades IGSS y Hospital Ángeles Guatemala

Corresponding author: Patricia Chang, MD PhD

How to cite an article: Chang P. Tophus., Our Dermatol Online 2012; 3(2): 131-133.


Tophus is a Latin word means „stone”, in plural is called tophi is a deposit of monosodium urate crystals in people with longstanding high levels of uric acid in the blood. Tophi are most commonly seen in conjunction with the disease of gout, and most people with tophi have already developed gouty symptoms previously [1]. Even though tophi are most commonly found as hard nodules around the fingers, at the tips of the elbows, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the ears, vocal cords, or around the spinal cord [2]. The pathognomonic lesion of gout, which appears grossly when preserved in alcohol or other non-aqueous solution as a nodular mass of white chalky, pasty material composed of crystalline and amorphous urates–eg, monosodium urate monohydrates, surrounded by mononuclear cells, fibroblasts and a foreign body-type giant cell reaction with epithelioid histiocytes [3]. Tophi may appear in the articular cartilage of joints and also in the periarticular ligaments, tendons and soft tissues including the olecranon and patellar bursae, Achilles tendons, and ear lobes. Less frequently they may appear in the kidneys, nasal cartilages, skin of the fingertips, palms and sole. Superficial tophi can lead to large ulcerations of the overlying skin [4].
Figure 1. Tophus on finger and toes
Figure 2. Tophus on fingers
Figure 3. Tophus in the proximal nail folds of finger
Figure 4. Tophus in the proximal nail folds of toes
Figure 5. Tophus on toes 
Figure 6. Piezogenic 
Figure 7a. Tophus on hands
Figure 7b. Tophus on hands

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