Gout on the Face and Skin: Tophi, Gouty Nodules

A nodule on the auricle or a firm formation under the skin of a finger is usually noticed by chance. In gout, such nodules are called tophi, and they do indeed occur on the skin. Below — what tophi are and what is worth asking a doctor about.

What tophi and tophaceous gout are

A tophus (from the Latin tofus — porous stone) is a general term for foci of pathological induration of the subcutaneous tissue. A gouty tophus, also known as a gouty nodule, is a deposit of uric acid crystals in soft tissues in the form of characteristic granulomas.

Gout is a type of arthritis: uric acid accumulates in the blood, crystals form in the fluid around the joints and cause inflammation with pain, swelling, and heat. Tophi form with high hyperuricemia and a disease duration of more than 5–6 years; this is a pathognomonic sign of gout. A blood uric acid level above 7.2 milligrams per deciliter is considered high, but not everyone with such a reading has gout.

Can gout occur on the face and ears

The ears are a typical site for tophi, along with the fingers and elbows. On the face, nodules are described on the forehead. Among the joints usually affected in gout are the big toe, other joints of the feet, the ankles, the hands, the wrists, the elbows, and the knees.

Cutaneous manifestations of gout and where else nodules appear

Gouty nodules are located in the subcutaneous tissue. Most often these are:

• the area of the joints of the hand and foot, the elbow joints;
• the auricles;
• the extensor surfaces of the forearms, thighs, and shins;
• the Achilles tendons and heels;
• the forehead.

The size of the nodules ranges from a few millimeters to 1–2 cm, the color is predominantly yellowish, and they are painless in themselves. During attacks, the contents may liquefy and be discharged through fistulas; the discharge from tophi is described as a chalky substance.

How a doctor confirms the nature of the nodules

During the appointment, the patient is asked about diet and alcohol, and the joints and nodules are examined. The level of uric acid in the blood and urine is determined, and synovial fluid analysis is performed — it shows uric acid crystals; a synovial membrane biopsy is possible. Joint X-rays may be normal. If the picture is unclear, the patient is referred to a rheumatologist: fluid is additionally taken from the affected joint with a thin needle, and if this is not possible, imaging is ordered.

Why tophaceous gout is dangerous and when to see a doctor

With repeated attacks without treatment, gout becomes chronic: joints are damaged, tophi form, kidney stones appear, and deposits in the kidneys lead to chronic renal failure. Nodules can be painful and interfere with daily life; inflammation of the periarticular bursae (bursitis) or tendons (tenosynovitis) with pain occurs nearby. Targets for blood uric acid: below 6 milligrams per deciliter, and with visible tophi — below 5 milligrams per deciliter.

You should see a doctor if symptoms of gouty arthritis have appeared for the first time, if the usual treatment does not help, or if tophi are detected. If, against a background of sudden pain and swelling in a joint, the pain intensifies, a very high temperature rises, chills, nausea appear, or the person cannot eat, you need to see a doctor urgently: such signs may indicate an infection inside the joint.

Tophi themselves are not a reason to call an ambulance; 103/112 — for signs of a life-threatening condition (for example, stroke or heart attack).

You can come to the appointment with questions: which examinations will confirm the nature of the nodules, whether the uric acid level is related to these formations, and whether follow-up with a rheumatologist is needed. This text is for reference and does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer