Hiker's Feet: Hidden Warning Skin Sign.

A 43-year-old previously healthy woman presented to our department due to progressive shortness of breath and arthralgia for a few weeks. A physical examination demonstrated the presence of roughness with hyperkeratosis and scaling at the pulp to the lateral surface of the first toe (Picture A, B), namely “Hiker's feet” (1), as well as mechanic's hands at the first fingers (figure not shown). Furthermore, periungual erythema, Gottron's signs in the elbows, knees, and dorsal surface of the hands (Picture C), and inverse (or reverse) Gottron's signs (2) in both palms were also noted (Picture D). Auscultation revealed fine crackles at the left lower lung. Although serum anti-synthetase antibody was negative, she was ultimately diagnosed with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis and urgently treated with combination immunosuppressive treatments. Her Hiker's feet dramatically regressed three days after the initiation of therapy (Picture E) and subsided over the next two weeks. Hiker's feet can be used synonymously with mechanic hands; however, physicians should be alert for this easily missed sign (1) to ensure a rapid diagnosis of anti-synthetase syndrome and/or anti-MDA5-associated dermatomyositis.

Picture.

The authors state that they have no Conflict of Interest (COI).