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Disseminated cutaneous gout: a rare manifestation of gout

Yoon Jin Choi1, Ji Yeon Byun1,*, You Won Choi1, Hae Young Choi1
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1Department of Dermatology, Ewha Womans University College of Medicine, Seoul, Korea
*Corresponding author: Ji Yeon Byun, Department of Dermatology, Ewha Womans University College of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea, Tel: 82-2-2650-5160, Fax: 82-2-2652-6925, E-mail:

© Copyright 2024 Ewha Womans University College of Medicine and Ewha Medical Research Institute. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Nov 07, 2023; Accepted: Dec 22, 2023

Published Online: Jan 31, 2024

A 51-year-old man presented with multiple inflammatory skin lesions on both lower legs that had developed 3 weeks prior. He had a 15-year history of gout and stage 3 chronic kidney disease. Upon physical examination, multiple yellowish, firm papulonodules with evidence of suppuration were noted on his shins, calves, knees, and ankles (Fig. 1). A skin biopsy revealed well-circumscribed deposits of pinkish, amorphous material in the deep dermis, surrounded by histiocytic infiltration and a fibrous reaction. Von Kossa staining did not show any calcium deposition (Fig. 2). The patient was diagnosed with disseminated cutaneous gout, and the skin lesions were treated symptomatically with topical steroids and oral antihistamines.

Fig. 1. Multiple yellowish, firm papulonodules had developed on both lower legs. Some lesions showed acute suppuration.
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Fig. 2. Well-circumscribed deposition of pinkish amorphous materials was noticed in the deep dermis. Histiocytic infiltration and fibrous reaction were observed surrounding the amorphous materials (hematoxylin and eosin, ×40). Inlet, Von Kossa staining showed no calcium deposition (×100).
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Gout is a chronic disease characterized by the deposition of monosodium urate (MSU) crystals, which form when urate concentrations are elevated [1]. These MSU crystals can accumulate in joints, bones, and various body tissues, including the skin and soft tissues. The disease can be categorized into four clinical stages: asymptomatic hyperuricemia, acute gout, intercritical gout (the period between gouty attacks), and chronic tophaceous gout [2]. Chronic tophaceous gout typically emerges after a decade or more of recurrent polyarticular gout. Gouty tophi are deposits of MSU crystals in and around joints, as well as in soft tissues. Cutaneous deposition of MSU crystals is commonly observed over joints or on the ears. Disseminated cutaneous gout is an uncommon skin manifestation of gout, characterized by widespread dermal or subcutaneous tophi that develop at extra-articular sites [3].

The gold standard for diagnosing gout is the identification of negatively birefringent, needle-shaped MSU crystals in synovial fluid or tophi. However, the formalin fixation of skin biopsy specimens can result in the dissolution of crystals, which means that MSU deposition typically appears as pink, amorphous material in routine histological examinations. Alcohol fixation is required for the preservation and identification of the urate crystals [4].

Ethics statement

Informed consent for publication of the images was obtained from the patient.

Author' Contribution

Conceptualization: Byun JY, Choi YW, Choi HY

Investigation: Choi YJ

Writing – original draft: Byun JY

Writing – review & editing: Choi YJ, Byun JY, Choi YW, Choi HY

Conflict of Interest

Ji Yeon Byun serves as the Vice Editor-in-Chief of the Ewha Medical Journal, but had no role in the decision to publish this article. No other potential conflict of interest relevant to this article was reported.


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Data availability

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Supplementary materials

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