Correspondence |

Curettage as an Acceptable Treatment for Gouty Tophi on the Ear

Amanda Elam, MD; Patrick E. McCleskey, MD
JAMA Dermatol. 2013;149(2):245-246. doi:10.1001/jamadermatol.2013.804.
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Report of a Case. A 48-year-old man with a 1-year history of gouty arthritis presented for evaluation of “white bumps” on his ears. Examination revealed several 2- to 5-mm firm, white papules on the bilateral helical rims (Figure 1A). Shave biopsy specimens were submitted in formalin and ethanol (Figure 2A). Crystals from the ethanol preparation were refractile (Figure 2B) and birefringent on cross-polarization (Figure 2C and D). Subsequently, the ears were cleansed and anesthetized using lidocaine, 2%, with 1:50 000 epinephrine prior to curettage. Tophi were removed with a 3-mm disposable curette until no chalky white material was visible; minor bleeding was controlled with aluminum chloride. The patient's primary care physician prescribed allopurinol, 300 mg/d, and colchicine, 0.6 mg/d, as needed for symptoms of an acute gouty arthritis attack. Initial serum uric acid level was 10.7 mg/dL; follow-up levels at 3 months and 1 year were 10.1 and 11.6 mg/dL, respectively. (To convert uric acid to micromoles per liter, multiply by 59.485.) No new tophi appeared despite uncontrolled serum uric acid levels. The patient was pleased with the cosmetic outcome (Figure 1B) 18 months after curettage.

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Figure 1. Clinical images. A, Multiple gouty tophi on the helix. B, Helix after curettage.

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Figure 2. Hematoxylin-eosin–stained tissue specimen fixed in ethanol showing uric acid crystals. A, Low-power view (original magnification ×4). B, Single polarization (original magnification ×4). C and D, Close-up cross-polarization images (original magnification ×20 for both).




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