The furrow deepens until spontaneous amputation takes
place, which rarely occurs, the patient generally hastening the
process by his own operation, or by seeking surgical treatment. A
dry scab forms at the furrow, and when picked and repicked
constantly re-forms, being composed of horny desquamation or
necrosis.
The histology of ainhum shows it to be a direct ingrowth of
epithelium, with a corresponding depression of surface due to a
rapid hyperplasia that pushes down and strangles the papillae,
thus cutting off the blood supply from the epithelial cells,
causing them to undergo a horny change.
The disease is not usually symmetric, as formerly stated, nor is
it simultaneous in different toes. There are no associated
constitutional symptoms, no tendency to similar morbid changes in
other parts, and no infiltration elsewhere. There is little or no
edema with ainhum. In ainhum there is, first, simple hypertrophy,
then active hyperplasia The papillae degenerate when deprived of
blood supply, and become horny. Meanwhile the pressure thus
exerted on the nervi vasorum sets up vascular changes which bring
about epithelial changes in more distant areas, the process
advancing anteriorly, that is, in the direction of the arteries.
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