Chronic microtraumatic digital pulpitis in plastic surgeons:
a common affliction seldom reported?
Adam R. Sawyer
Received: 5 January 2010 / Accepted: 3 June 2010 /Published online: 17 June 2010
Introduction Chronic microtraumatic digital pulpitis is a
painful, fissuring dermatitis of the dominant finger pulps
associated with repetitive traumatic injury to the hands. It is
regarded as an occupational hazard and has been reported
in chefs, postal workers and dental technicians.
Case reports We present two cases of progressive digital
pulpitis in plastic surgeons secondary to surgical instrument
chronic microtrauma and repetitive washing and disinfection.
Their symptoms had progressed from minor erythema and
flaking of the finger pulp skin to more severe skin loss,
fissuring and hyperkeratosis. Dermatologists’ opinions were
sought, and the management strategy has been conservative.
Regular emollients and topical steroids have provided some
symptomatic relief but have failed to effectively treat the
affected areas or prevent recurrence. These represent the first
reported cases of chronic digital pulpitis in surgeons.
Discussion This condition is chronic, progressive and painful
and is related to operative workload. It can be associated with
significant physical morbidity and considerable distress and
anxiety for the surgeon affected. Little is known about the
pathogenesis and management is primarily conservative,
although it provides little relief in most cases. This condition
is likely to be common amongst surgeons and should gain
greater recognition as a potential occupational hazard in
Keywords Digital pulpitis
Pulpitis is dermatitis of the pulps of the fingers. It usually
represents a contact dermatitis from recurrent exposure to
chemical irritants. It can, however, in rare circumstances also
present as a mechanical dermatitis from recurrent microtrauma
to the digital pulps. We present the first reported cases of
chronic traumatic digital pulpitis affecting two plastic surgeons.
The first surgeon presented with a 5-year history of
progressive symptoms of tenderness and scaling, leading to
fissuring and bleeding. This affects predominately the pulp of
the thumb but also to a lesser degree the index, middle, ring
and little fingers of the dominant right hand, in a decreasing
order. The non-dominant hand is not affected (Fig. 1).
The second surgeon presented with an 8-year history of
intermittent and progressively worsening symptoms in all
digits of his dominant right hand, with the thumb, index
and middle fingers worst affected.
Their symptoms had evolved from minor erythema and
flaking of the pulpal skin to more severe skin loss, fissuring
and hyperkeratosis. The symptoms are intermittent and related
to the intensity of the operative workload. Both surgeons
report that periods of busy operating schedules coincided
reliably with flare-ups in the painful inflammation of the
finger pulps with bleeding and fissuring. During holiday
periods, their symptoms would virtually disappear.
A. Harb (*)
A. R. Sawyer
Plastic Surgery Unit, Queen Alexandra Hospital,
Eur J Plast Surg (2011) 34:289–291