Home / Deep Research / Ainhum

Ainhum

Disease Pathophysiology Research Report

2026-02-04
Falcon MONDO:0007074 Model: Edison Scientific Literature 13 citations

Disease Pathophysiology Research Report

Target Disease - Disease Name: Ainhum (dactylolysis spontanea) - MONDO ID: not available in retrieved sources - Category: Complex

Pathophysiology description Ainhum is an idiopathic, mutilating dermatological disorder characterized by a progressive constricting annular band that classically forms at the base of the fifth toe and deepens circumferentially to produce distal swelling, osteolysis, and eventual spontaneous, typically bloodless auto‑amputation. The annular band behaves as a fibrous scar “ligature,” whose contraction promotes localized anoxia/ischemia and necrosis while perpetuating chronic wound repair and dermal fibrosis. Histopathology described in case series and reviews includes marked epidermal hyperkeratosis and acanthosis adjacent to the band, with a dermal inflammatory infiltrate (lymphocytes, plasma cells) and increased fibroblasts within a collagenous, fibrotic band. Radiographs (when obtained) show a radiolucent constricting ring near the base of the affected toe with tapering and osteolysis of the distal phalanx. Ischemic contributions are supported by reports of “arterial narrowing” in intermediate stages, and some angiographic studies report distal plantar arch abnormalities, although peripheral pulses can remain palpable; a neuropathic component is suggested by early pain and by mechanical nerve compression within the tightening band. Distinguishing idiopathic ainhum from pseudo‑ainhum (constriction bands with identifiable causes) is critical: pseudo‑ainhum may arise from congenital bands, hereditary palmoplantar keratoderma (PPK) syndromes (notably connexin‑related), trauma, infections, or systemic connective tissue diseases. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4, jemmott2007anunusualcause pages 4-4, tchouakam2019ainhumarare pages 1-3, govender2023palmoplantarkeratodermapseudoainhum pages 1-2)

Core Pathophysiology - Primary mechanisms: Progressive formation and contraction of a fibrosed collagen band at the base of the digit, acting as a constricting ligature; resultant local ischemia (anoxia) and tissue necrosis; chronic injury–repair cycle with dermal fibrosis; epidermal hyperproliferation and disordered differentiation adjacent to the band; distal osteolysis. (jemmott2007anunusualcause pages 2-4, tchouakam2019ainhumarare pages 3-4) - Dysregulated molecular/cellular pathways: Tissue fibrosis and extracellular matrix remodeling; inflammatory cell infiltration; keratinocyte differentiation/hyperkeratosis; ischemia/hypoxia responses in local tissues; mechanical compression of neurovascular structures. While idiopathic ainhum lacks a proven genetic driver, pseudo‑ainhum in hereditary PPK implicates gap junction biology (connexins) and disruption of epidermal calcium gradients that regulate keratinocyte differentiation. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, tchouakam2019ainhumarare pages 3-4) - Affected cellular processes: Keratinocyte proliferation and differentiation (hyperkeratosis, acanthosis); fibroblast activation and collagen deposition (fibrous band); endothelial/vascular tone and perfusion locally (ischemia/arterial narrowing); nociceptive signaling and nerve compression. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4)

Key Molecular Players - Genes/Proteins (implicated primarily in pseudo‑ainhum associated with hereditary PPK rather than idiopathic ainhum): - GJB2 (Connexin 26), GJB4 (Connexin 30.3), GJB6 (Connexin 30), GJA1 (Connexin 43): connexin genes expressed in skin; mutations in connexin genes are linked to PPK with pseudo‑ainhum/annular constriction and related phenotypes (e.g., Vohwinkel, Bart–Pumphrey, KID syndromes), reflecting perturbed gap‑junction intercellular communication and epidermal differentiation. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, govender2023palmoplantarkeratodermapseudoainhum pages 7-8) - Chemical entities: Calcium ion (Ca2+)—connexin dysfunction can disrupt the epidermal calcium gradient that orchestrates keratinocyte differentiation; inflammatory mediators likely contribute but are not specifically delineated in idiopathic ainhum. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4) - Cell types: Keratinocytes (hyperkeratosis/acanthosis), dermal fibroblasts (fibrous collagen band), endothelial cells (arterial narrowing/ischemia), peripheral sensory neurons (pain/neuropathy hypothesis). (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4) - Anatomical locations: Plantar skin at the base of the fifth toe (most common site), epidermis/dermis of the affected digit, digital arteries. (tchouakam2019ainhumarare pages 1-3, tchouakam2019ainhumarare pages 3-4)

Biological Processes (GO-style annotation, mechanistically implicated) - Gap junction intercellular communication (connexin-related pseudo‑ainhum in PPK) and epidermal calcium homeostasis/keratinocyte differentiation. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4) - Dermal fibrosis and extracellular matrix organization at the constriction band; wound healing/inflammatory response. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4) - Response to hypoxia/ischemia at the distal digit; osteolysis/bone resorption in advanced stages. (tchouakam2019ainhumarare pages 3-4)

Cellular Components - Epidermis (stratum corneum, stratum spinosum) with hyperkeratosis and acanthosis adjacent to the band; dermis with fibrosed collagen band and inflammatory infiltrate; periarterial regions/digital arteries implicated in ischemia; peripheral nerve bundles traversing the band. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4)

Disease Progression The classic four-stage evolution (Cole/Browne framework) involves: stage 1—initial clavus/scaling fissure forming a shallow annular groove at the medial plantar base of the fifth toe; stage 2—deepening constricting band with a globular distal toe, ulceration, and “bone resorption and arterial narrowing”; stage 3—further compression with fracture/separation and hypermobility of the distal phalanx; stage 4—“a bloodless auto‑amputation.” These stages guide management, with earlier stages amenable to band excision/Z‑plasty and later stages often requiring amputation. (tchouakam2019ainhumarare pages 3-4, tchouakam2019ainhumarare pages 1-3, jemmott2007anunusualcause pages 4-4)

Phenotype–mechanism correlations - Constriction ring of the digit and distal bulbous swelling: correlates with a dermal collagenous fibrous band that contracts like scar tissue, acting as a ligature and promoting ischemia. (jemmott2007anunusualcause pages 2-4) - Plantar hyperkeratosis adjacent to the band: reflects keratinocyte hyperproliferation and disturbed differentiation; in pseudo‑ainhum with PPK, connexin defects further perturb epidermal homeostasis. (tchouakam2019ainhumarare pages 3-4, govender2023palmoplantarkeratodermapseudoainhum pages 2-4) - Osteolysis and tapering of distal phalanx: consequence of chronic ischemia and mechanical stress distal to the constriction. (tchouakam2019ainhumarare pages 3-4) - Pain and neuropathic complaints early in disease: may reflect nerve compression by the tightening band. (jemmott2007anunusualcause pages 2-4)

Distinction from pseudo‑ainhum Idiopathic ainhum is defined by spontaneous, idiopathic constriction, typically of the fifth toe in individuals of African descent, whereas pseudo‑ainhum denotes constriction bands secondary to identifiable causes: congenital bands (amniotic/Streeter), hereditary PPK and related genodermatoses (connexinopathies), trauma, infections (leprosy, mycoses, syphilis), inflammatory dermatoses (psoriasis), and connective tissue diseases (scleroderma, DLE). Pseudo‑ainhum is not restricted to the fifth toe and is more broadly distributed across digits and patient populations. (govender2023palmoplantarkeratodermapseudoainhum pages 1-2, jemmott2007anunusualcause pages 4-4)

Current applications and real‑world implementations - Diagnosis and staging: Clinical recognition of the annular groove and staging guide management. Plain radiography can show the radiolucent ring and osteolysis; vascular assessment may note arterial narrowing. (tchouakam2019ainhumarare pages 3-4, tchouakam2019ainhumarare pages 1-3) - Interventions: Early stages (1–2) may be managed with surgical band excision and Z‑plasty to relieve constriction; advanced stages (3–4) often require amputation. Some reports suggest that once bone is involved, band‑disrupting procedures may not halt progression, supporting timely intervention. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 4-4) - Awareness in wound care: Underdiagnosis is noted; clinicians managing chronic toe ulcers in at‑risk populations should consider ainhum/pseudo‑ainhum in the differential. (jemmott2007anunusualcause pages 4-4)

Expert opinions and analysis - The fibrosed collagen band’s behavior “like a scar” that forms a ligature provides a coherent mechanistic link between histopathology (fibrosis), local ischemia/anoxia, and the stereotyped clinical evolution to auto‑amputation; this aligns with the observed benefit of early surgical release. (jemmott2007anunusualcause pages 2-4, tchouakam2019ainhumarare pages 3-4) - The idiopathic nature of ainhum contrasts with pseudo‑ainhum’s identifiable causes; in hereditary PPK‑associated pseudo‑ainhum, connexin mutations provide a molecular entry point (gap junction dysfunction and calcium‑dependent differentiation), but such molecular drivers are not established for idiopathic ainhum. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, govender2023palmoplantarkeratodermapseudoainhum pages 1-2)

Relevant statistics and data - Typical site and staging: Fifth toe is the most commonly affected digit, with a four‑stage natural history culminating in “bloodless auto‑amputation”; radiography shows a constricting radiolucent ring and distal osteolysis/tapering in advanced stages. (tchouakam2019ainhumarare pages 1-3, tchouakam2019ainhumarare pages 3-4) - Vascular findings: Reports include “arterial narrowing” at intermediate stages and angiographic distal plantar arch abnormalities in some patients, supporting an ischemia component despite sometimes normal pulses. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4)

Ontology‑linked annotations and evidence table | Category | Entity (preferred label) | Ontology + ID | Role/Notes | Evidence | |---|---|---|---|---| | Gene/Protein | GJB2 (Connexin 26) | HGNC:GJB2 | Connexin gap-junction protein implicated in hereditary PPK / pseudo-ainhum mechanisms (disrupts intercellular communication) | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Gene/Protein | GJB4 (Connexin 30.3) | HGNC:GJB4 | Variant reported as VUS in PPK/pseudo-ainhum case; implicates connexin dysfunction in epidermal phenotype | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Gene/Protein | GJB6 (Connexin 30) | HGNC:GJB6 | Reported pathogenic variant (e.g., p.Gly59Arg) in connexin-related PPK with pseudo-ainhum features | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Gene/Protein | GJA1 (Connexin 43) | HGNC:GJA1 | Connexin expressed in skin; implicated broadly in epidermal gap-junction biology relevant to keratoderma syndromes | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Biological process | Gap junction intercellular communication | GO:Gap_junction_intercellular_communication | Core process by which connexins regulate epidermal homeostasis; dysfunction linked to hyperkeratosis/pseudo-ainhum | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Biological process | Keratinocyte differentiation | GO:Keratinocyte_differentiation | Altered differentiation (hyperkeratosis, acanthosis) observed in cases and associated with connexin defects | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, tchouakam2019ainhumarare pages 3-4), DOI: 10.1177/2050313x231204197; DOI: 10.1186/s12895-019-0092-6 | | Biological process | Epidermal calcium ion homeostasis | GO:Epidermal_calcium_ion_homeostasis | Connexin dysfunction can perturb the epidermal Ca2+ gradient, a regulator of keratinocyte maturation | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Biological process | Dermal fibrosis | GO:Dermal_fibrosis | Fibroblast-mediated fibrosis beneath constriction band contributes to progressive tightening and groove formation | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Biological process | Response to hypoxia / ischemia-related processes | GO:Response_to_hypoxia | Ischemia/vascular compromise proposed as a contributor to distal tissue loss and osteolysis | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Cell type | Keratinocyte | CL:Keratinocyte | Primary epidermal cell showing hyperkeratosis/acanthosis; central to PPK and pseudo-ainhum pathology | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, tchouakam2019ainhumarare pages 3-4), DOI: 10.1177/2050313x231204197; DOI: 10.1186/s12895-019-0092-6 | | Cell type | Fibroblast | CL:Fibroblast | Dermal fibroblasts form fibrous band and participate in chronic inflammation/fibrosis at constriction site | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Cell type | Endothelial cell | CL:Endothelial_cell | Vascular endothelium implicated in ischemia hypothesis; vascular compromise may drive distal changes | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Cell type | Peripheral sensory neuron | CL:Peripheral_sensory_neuron | Peripheral neuropathy proposed in some series as contributing factor to disease evolution | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Anatomical site | Fifth toe | UBERON:Fifth_toe | Classic and most commonly affected digit in idiopathic ainhum cases | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Anatomical site | Skin of foot (plantar skin) | UBERON:Skin_of_foot | Site of plantar hyperkeratosis and constriction-band formation in pseudo-ainhum/PPK-associated cases | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, tchouakam2019ainhumarare pages 3-4), DOI: 10.1177/2050313x231204197; DOI: 10.1186/s12895-019-0092-6 | | Anatomical site | Epidermis | UBERON:Epidermis | Epidermal changes reported (hyperkeratosis, acanthosis) adjacent to constriction | (govender2023palmoplantarkeratodermapseudoainhum pages 1-2, tchouakam2019ainhumarare pages 3-4), DOI: 10.1177/2050313x231204197; DOI: 10.1186/s12895-019-0092-6 | | Anatomical site | Dermis | UBERON:Dermis | Dermal lymphocytic infiltrate and fibrosis reported in histology of constriction bands | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Anatomical site | Digital arteries | UBERON:Digital_arteries | Vascular structures implicated by ischemia hypothesis for progressive distal tissue loss | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Chemical entity | Calcium ion (Ca2+) | CHEBI:Calcium_ion | Key regulator of keratinocyte differentiation; connexin disruption reported to affect epidermal Ca2+ gradient | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4), DOI: 10.1177/2050313x231204197, https://doi.org/10.1177/2050313x231204197 | | Phenotype | Constriction ring of digit | HPO:Constriction_ring_of_digit | Clinical hallmark (annular groove) that tightens and may progress to auto-amputation | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Phenotype | Plantar hyperkeratosis | HPO:Plantar_hyperkeratosis | Associated PPK phenotype seen in pseudo-ainhum and familial keratoderma cases | (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, tchouakam2019ainhumarare pages 3-4), DOI: 10.1177/2050313x231204197; DOI: 10.1186/s12895-019-0092-6 | | Phenotype | Auto-amputation of digit | HPO:Auto_amputation | End-stage outcome of progressive constriction band (documented in case series) | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 | | Phenotype | Osteolysis of phalanges | HPO:Osteolysis_of_phalanges | Radiographic finding (tapering/resorption) in advanced stages | (tchouakam2019ainhumarare pages 3-4), DOI: 10.1186/s12895-019-0092-6, https://doi.org/10.1186/s12895-019-0092-6 |

Table: Table mapping key genes, processes, cells, anatomical sites, chemicals and phenotypes for Ainhum (dactylolysis spontanea) to ontology labels with concise roles and primary evidence (context IDs and DOIs). This supports structured annotation and citation for a disease knowledge base.

Evidence quotes for key claims

"a bloodless auto-amputation" (tchouakam2019ainhumarare pages 3-4) "thickening of the stratum corneum near the fibrous band, hyper-keratosis or acanthosis of the epidermis and the presence of lymphocytes and fibroblasts in the dermis" (tchouakam2019ainhumarare pages 3-4) "fibrosed collagen band contracts like a scar, forming a ligature that causes localised anoxia and necrosis" (jemmott2007anunusualcause pages 2-4) "bone resorption and arterial narrowing" (tchouakam2019ainhumarare pages 3-4) "distinguishes ainhum (idiopathic, classically affecting the fifth toe) from pseudo-ainhum (constriction bands with identifiable causes)" (govender2023palmoplantarkeratodermapseudoainhum pages 1-2)

Blockquote: Verbatim, citable excerpts from retrieved sources summarizing staging (auto-amputation), histopathology (hyperkeratosis, inflammatory infiltrate, fibroblast/fibrosis), ischemic/osteolytic findings, and the clinical distinction between ainhum and pseudo-ainhum; useful as direct evidence for a pathophysiology report.

Structured Annotations - Genes/Proteins (HGNC): GJB2; GJB4; GJB6; GJA1 (implicated in pseudo‑ainhum due to PPK). (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, govender2023palmoplantarkeratodermapseudoainhum pages 7-8) - Biological processes (GO): gap junction intercellular communication; keratinocyte differentiation; epidermal calcium ion homeostasis; dermal fibrosis; response to hypoxia. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4) - Cell types (CL): keratinocyte; fibroblast; endothelial cell; peripheral sensory neuron. (tchouakam2019ainhumarare pages 3-4, jemmott2007anunusualcause pages 2-4) - Anatomical locations (UBERON): fifth toe; skin of foot; epidermis; dermis; digital arteries. (tchouakam2019ainhumarare pages 1-3, tchouakam2019ainhumarare pages 3-4) - Chemical entities (CHEBI): calcium ion. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4) - Phenotypes (HPO): constriction ring of digit; plantar hyperkeratosis; auto‑amputation; osteolysis of phalanges. (tchouakam2019ainhumarare pages 3-4)

Evidence items with PMIDs/DOIs/URLs and publication dates - Govender KC, Pillay S. Palmoplantar keratoderma, pseudo‑ainhum and knuckle pads in an African patient: A case report. SAGE Open Medical Case Reports. 2023 Jan; doi:10.1177/2050313x231204197. URL: https://doi.org/10.1177/2050313x231204197 (supports pseudo‑ainhum vs ainhum distinction; connexin biology; keratinocyte differentiation and epidermal calcium gradient disruption) (govender2023palmoplantarkeratodermapseudoainhum pages 7-8, govender2023palmoplantarkeratodermapseudoainhum pages 2-4, govender2023palmoplantarkeratodermapseudoainhum pages 1-2) - Tchouakam DN, Tochie JN, Guifo ML, Choukem SP. Ainhum, a rare mutilating dermatological disease in a female Cameroonian: a case report. BMC Dermatology. 2019 Aug; doi:10.1186/s12895-019-0092-6. URL: https://doi.org/10.1186/s12895-019-0092-6 (supports staging, imaging features, histopathology summary, proposed etiologies including ischemia/neuropathy/trauma/infection/genetic keratoderma) (tchouakam2019ainhumarare pages 3-4, tchouakam2019ainhumarare pages 1-3) - Jemmott T, Foster AV, Edmonds ME. An unusual cause of ulceration: ainhum (dactylolysis spontanea). International Wound Journal. 2007 Sep;4:251–254. doi:10.1111/j.1742-481x.2007.00297.x. URL: https://doi.org/10.1111/j.1742-481x.2007.00297.x (supports fibrosed collagen band behaving like a scar ligature; histopathology details; neuropathy/ischemia considerations; treatment implications and underdiagnosis emphasis) (jemmott2007anunusualcause pages 2-4, jemmott2007anunusualcause pages 4-4)

Limitations and open questions - Idiopathic ainhum currently lacks a defined molecular driver; most molecular insights derive from pseudo‑ainhum in hereditary PPK (connexinopathies). Prospective histopathology with molecular profiling (fibrosis, ECM, neurovascular changes) would clarify mechanisms and therapeutic targets. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4, jemmott2007anunusualcause pages 2-4)

References: context IDs are provided inline; URLs and DOIs included above for accessibility.

References

  1. (govender2023palmoplantarkeratodermapseudoainhum pages 7-8): Kellicia Courtney Govender and Somasundram Pillay. Palmoplantar keratoderma, pseudo-ainhum and knuckle pads in an african patient: a case report. SAGE Open Medical Case Reports, Jan 2023. URL: https://doi.org/10.1177/2050313x231204197, doi:10.1177/2050313x231204197. This article has 3 citations and is from a peer-reviewed journal.

  2. (tchouakam2019ainhumarare pages 3-4): Diego Nitcheu Tchouakam, Joel Noutakdie Tochie, Marc Leroy Guifo, and Simeon Pierre Choukem. Ainhum, a rare mutilating dermatological disease in a female cameroonian: a case report. BMC Dermatology, Aug 2019. URL: https://doi.org/10.1186/s12895-019-0092-6, doi:10.1186/s12895-019-0092-6. This article has 16 citations and is from a peer-reviewed journal.

  3. (govender2023palmoplantarkeratodermapseudoainhum pages 2-4): Kellicia Courtney Govender and Somasundram Pillay. Palmoplantar keratoderma, pseudo-ainhum and knuckle pads in an african patient: a case report. SAGE Open Medical Case Reports, Jan 2023. URL: https://doi.org/10.1177/2050313x231204197, doi:10.1177/2050313x231204197. This article has 3 citations and is from a peer-reviewed journal.

  4. (govender2023palmoplantarkeratodermapseudoainhum pages 1-2): Kellicia Courtney Govender and Somasundram Pillay. Palmoplantar keratoderma, pseudo-ainhum and knuckle pads in an african patient: a case report. SAGE Open Medical Case Reports, Jan 2023. URL: https://doi.org/10.1177/2050313x231204197, doi:10.1177/2050313x231204197. This article has 3 citations and is from a peer-reviewed journal.

  5. (jemmott2007anunusualcause pages 2-4): Timothy Jemmott, Alethea V Foster, and Michael E Edmonds. An unusual cause of ulceration: ainhum (dactylolysis spontanea). International Wound Journal, 4:251-254, Sep 2007. URL: https://doi.org/10.1111/j.1742-481x.2007.00297.x, doi:10.1111/j.1742-481x.2007.00297.x. This article has 22 citations and is from a peer-reviewed journal.

  6. (jemmott2007anunusualcause pages 4-4): Timothy Jemmott, Alethea V Foster, and Michael E Edmonds. An unusual cause of ulceration: ainhum (dactylolysis spontanea). International Wound Journal, 4:251-254, Sep 2007. URL: https://doi.org/10.1111/j.1742-481x.2007.00297.x, doi:10.1111/j.1742-481x.2007.00297.x. This article has 22 citations and is from a peer-reviewed journal.

  7. (tchouakam2019ainhumarare pages 1-3): Diego Nitcheu Tchouakam, Joel Noutakdie Tochie, Marc Leroy Guifo, and Simeon Pierre Choukem. Ainhum, a rare mutilating dermatological disease in a female cameroonian: a case report. BMC Dermatology, Aug 2019. URL: https://doi.org/10.1186/s12895-019-0092-6, doi:10.1186/s12895-019-0092-6. This article has 16 citations and is from a peer-reviewed journal.