Purpose or Case Report: Acroosteolysis (AO) is a rare manifestation of bone resorption that can occur in both genders and is not limited to a specific population. AO can be familial, idiopathic, occupational or secondary. It is marked by distal phalangeal bone resorption and often arises as a secondary manifestation of underlying musculoskeletal, dermatological, or endocrine conditions. Tuft resorption is often associated with conditions like systemic sclerosis, ischemia, hyperparathyroidism, and neurologic disorders, while the destruction of the distal interphalangeal joint is more frequently observed in inflammatory conditions like psoriatic arthritis. Familial AO affects only the feet and is associated with plantar ulcerations. AO due to vinyl chloride exposure is associated with papules and nodules on the hands and forearms and thickening of the skin of the hands. Clinically, AO is marked by a gradual tapering/thinning of the bones in the distal phalanges, resulting in a narrower appearance compared to normal digits. This process is accompanied by reduced bone density in the affected areas, which can be readily observed on radiographic imaging. It is often associated with distal digital ischemia, digital calcinosis, or severe sensory neuropathy. Nail changes in AO include brachyonychia, anonychia, atrophy, transverse ridges, discoloration, thickening of the nail plate, hyperkeratosis of the cuticles, pincer nail, pitted onycholysis, longitudinal ridging, and pterygium. X-ray images typically reveal distinctive bone resorption at the fingertips and toes, while CT scans may show areas of decreased bone density or erosions in the distal phalanges. MRI can detect soft tissue alterations, joint effusion, and inflammation. Beyond the physical changes, patients may experience pain, joint deformities, and reduced functionality in the affected extremities. Treatment mainly involved managing the primary disease causing AO.

Learning Objectives:
1) To elucidate the clinical and radiological features of AO like the resorption seen in the distal phalanges.
2) To provide insight into the diverse underlying causes of AO, including associated medical conditions.
3) Understand cutaneous changes in AO to assist in the early recognition and prevention of disease progression.

Conclusion:
A comprehensive understanding of acroosteolysis, including its clinical presentation, radiological findings, and associated etiological factors, is crucial for accurate diagnosis and appropriate management.
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