Fingers Of Hand Research Articles

Shape-Based Features for Optimized Hand Gesture Recognition

Gesture recognition is the most intuitive form of human-computer interface. Hand gestures provide a natural way for humans to interact with computers to perform a variety of different applications. However, factors such as complexity of hand gesture structures, differences in hand size, hand posture, and environmental illumination can influence the performance of hand gesture recognition algorithms. Considering the above factors, this paper aims to present a real time system for hand gesture recognition on the basis of detection of some meaningful shape-based features like orientation, center of mass, status of fingers, thumb in terms of raised or folded fingers of hand and their respective location in image. The internet is growing at a very fast pace. The use of web browser is also growing. Everyone has at least two or three most frequently visited website. Thus, in this paper, effectiveness of the gesture recognition and its ability to control the browser via the recognized hand gestures are experimented and the results are analyzed.

THE EFFECTS OF MODERATE INTENSITY AEROBIC EXERCISES UPON HEART RECOVERY OF COLLEGE GIRLS

The existing stud was aimed to observe effects of moderate intensity aerobic exercises upon heart recovery of college girls. The study was experimental by using longitudinal data collection approach i.e., pre-test and post-test. Total participants in study were 40. The selected population was randomly being divided into two groups, “experimental and control group”. The experimental group gained special treatment for a period of 8 weeks. The heart beat was checked through Radial artery which is easily felt on thumb side of the wrist of arm. For radial artery, three fingers of hand used. After the completion of eight-week exercise protocol data of RHR the data of pretest and posttest was recorded and analyzed “using paired sample t test” to see the difference between the RHR score of girls in pre-test and post-test. It was concluded that the “there is significant impact of Moderate intensity aerobic exercises upon Resting” Heart Rate. Study provides significant information in reaching the conclusion of the current research study.

Tenosynovitis of flexor tendons of hand: Tubercular etiology

Extra-pulmonary Tuberculosis (EPTB), 10% about is musculoskeletal cases. A middle age female who presented to outpatient department of tertiary care center (Medical college & Hospital) with swelling over volar surface of right distal forearm gradually increased in size over 9 to 10 months. She noticed difficulty to move fingers of right hand as size of swelling increasing. She had tingling sensation in the territory of median nerve. It was single swelling of 05cm x 07cm over the volar surface of right distal forearm with defined margins. Lesion was open surgically and rice bodies were found. Histopathological examination had shown caseous type of necrosis and granuloma formation suggestive of tuberculosis. Anti-tuberculosis treatment was given to her. Cases of TB tenosynovitis are uncommon and diagnosis is often missed causing delay of treatment to patient. Surgical intervention decided by symptoms and signs. Antitubercular therapy and excision of lesion produce good outcome. Keywords: Anti TB treatment; Rice Bodies; Surgical excision; Tenosynovitis.

Stretchable triboelectric sensor for measurement of the forearm muscles movements and fingers motion for Parkinson's disease assessment and assisting technologies

AbstractParkinson's disease (PD) is a degenerative, neurological disease that causes motor dysfunctions on the patient. Currently, the symptoms and progression of the disease are assessed by physicians who diagnose through careful observation, according to the Movement Disorder Society (MDS)‐sponsored Revision of the Unified Parkinson's Disease Rating Scale (UPDRS). In this manuscript, we report a portable sensor device based on a flexible Triboelectric Nanogenerator (TENG) formed from a dielectric material with a size of 4 cm × 3.5 cm and an aluminium (Al) electrode with dimensions of 2 mm × 3 mm, to monitor the movement of forearm muscles and tendons. When the hand or fingers extend or flex, the short gap between the dielectric polymer and the small conductor changes, generating a voltage due to triboelectric contact. The device is used to assess localized bradykinesia and rigidity of fingers and hands, as well as wrist and arm tremors. The voltage signal of the proposed sensor shows different waveform shapes, time duration and amplitude for each level of classification from ‘normal’ to ‘moderate’ status, described on the MDS‐UPDRS examination of hand movement, finger tapping and pronation–supination movement. Hence, we demonstrated that the proposed sensor can potentially be used for quantification of the symptoms and diagnosing. In addition, single finger motion tracking is also achieved by placing the triboelectric sensor in different positions around the forearm, close to the tendon connected to the finger under test. This way we avoid the placement of the sensor directly on the fingers, improving comfortability and long‐term wearability. The presented TENG sensor is fully integrated with the processing and the transmission board exploring new opportunities for triboelectric transducers in small motion detection of muscles. The future aim of this research is to provide real‐time monitoring of the disease progression as feedback for personalized treatment of the PD patients.

A Soft Five-Fingered Hand Actuated by Shape Memory Alloy Wires: Design, Manufacturing, and Evaluation.

This work presents a novel five-fingered soft hand prototype actuated by Shape Memory Alloy (SMA) wires. The use of thin (100 μm diameter) SMA wire actuators, in conjunction with an entirely 3D printed hand skeleton, guarantees an overall lightweight and flexible structure capable of silent motion. To enable high forces with sufficiently high actuation speed at each fingertip, bundles of welded actuated SMA wires are used. In order to increase the compliance of each finger, flexible joints from superelastic SMA wires are inserted between each phalanx. The resulting system is a versatile hand prototype having intrinsically elastic fingers, which is capable to grasp several types of objects with a considerable force. The paper starts with the description of the finger hand design, along with practical considerations for the optimal placement of the superelastic SMA in the soft joint. The maximum achievable displacement of each finger phalanx is measured together with the phalanxes dynamic responsiveness at different power stimuli. Several force measurement are also realized at each finger phalanx. The versatility of the prototype is finally demonstrated by presenting several possible hand configurations while handling objects with different sizes and shapes.

Correlation of Width of Anterior Maxillary Teeth with the Intercanine Distance, Distance from Inner to Outer Canthus of Right Eye and Width of First Three Fingers of Right Hand for Teeth Selection

Correlation of Width of Anterior Maxillary Teeth with the Intercanine Distance, Distance from Inner to Outer Canthus of Right Eye and Width of First Three Fingers of Right Hand for Teeth Selection

Dactylographic and dermatoglyphic characteristic of papillary fingerprint ridge patterns of serial killers who committed acquisitive crime

In order to verify the conclusions made by other scholars that based on the traces of papillary ridges of fingers and hands using dermatoglyphic methods in forensics allow composing portrait of a suspect, the authors of the articled analyzed the dactylographic and dermatoglyphic characteristics contained in the accurate dactylographic profiles of the known serial killers who committed acquisitive crimes. Choice of this motive is explained by the fact that both males and females were driven by it. The subject of this research is the types of papillary fingerprint ridges, dactylographic formulas, pattern of ridges, presence or absence of symmetry of the same type of ridge on the same fingers of both hands, and delta index. Research methodology is based on the analysis of modern scientific provisions of dactyloscopy and dermatoglyphics. Considerable attention is given to the use of private scientific methods of cognition: description, comparison of characteristics of papillary fingerprint ridge patterns of serial killers. The application of these methods of cognition allowed concluding on the absence of undisputed evidence of papillary fingerprint ridge patterns of criminal nature, namely an increase in the number of arched ridges in calculating the frequency of ridges on separate fingers. This article is first to analyze not only the accumulated unique empirical material, but also presents the images for getting a fuller representation on the known serial criminals.

Finger blood flow after the cold challenge with primary Raynaud's syndrome: a case report.

Background Raynaud’s syndrome is a commonly encountered disorder. The relationship between the grade of Raynaud’s phenomenon and severity of vasoconstriction is unclear. Recently, various methods including colour Doppler ultrasonography have been used for assessment of vascularity of the extremities including fingers.Case summary A 53-year-old man had a 6-year history of Raynaud’s phenomenon with typical tri-coloured changes proceeding from white, blue to red and slight pain and slight paresthaesia in the fingers of both hands when his fingers were exposed to cold. He was diagnosed with primary Raynaud’s syndrome. After treatment with the calcium channel blocker amlodipine (5 mg once daily), a cold challenge did not induce Raynaud’s phenomenon on the fingers in the present patient. After the cold challenge, colour Doppler ultrasonography showed that vascularity was markedly decreased or was absent, whereas there was little difference in skin colour of the fingers.Discussion In Raynaud's phenomenon, vasospasm may occur even if the symptoms are well-controlled with a calcium channel blocker. It is unlikely that clinical symptoms in patients with Raynaud’s syndrome always reflect the severity of vasoconstriction in their fingers.

Study of Hand and Finger Indices for Prediction of Sex and Estimation of Stature in a Sample of Egyptian and Malaysian Youth

Identification is a cornerstone in forensic investigations. The present study aimed to evaluate hand indices as a potential tool for determination of sex and estimation of stature in a sample of Egyptian and Malaysian people. The study included 200 Egyptian and 100 Malaysian participants. Stature was measured using a stadiometer. Hand length, hand breadth, index finger length, and ring finger length were measured using Vernier caliper. The hand index was computed by the following formula: (hand breadth/hand length) x 100. The ratio of the index to the ring finger (D2:D4 ratio) was calculated by dividing the length of index by the length of the ring finger of the same hand. All measurements were significantly higher in male than female subjects, except for the D2:D4 ratio which was significantly higher in female than in male subjects in either population. In Egyptian participants, the best measurement for sex discrimination was hand length in both hands (AUC: Rt=0.892, Lt: AUC=0.898). In Malaysian participants, the best measurement for sex discrimination was hand breadth in both hands (Rt: AUC=0.949, Lt: AUC=0.959). In all groups, there was positive, significant, moderate-strong correlation between stature and each of hand length, hand breadth, index finger length, and ring finger length. Backward elimination multiple regression was performed to developed models for stature estimation for each population using measurements from one hand. In conclusion, hand dimensions can serve as a tool to predict sex and calculate stature with reasonable accuracy in Egyptian and Malaysian youths.

Isolated Macrodactyly

A 5-year-old boy was brought to the outpatient department by his parents with complaints of the enlarged index finger of the left hand since birth. According to the mother, at birth, the index finger of the left hand was larger and longer than the other fingers of the same hand. The index finger grew out of proportion since then. The parents gave no history of congenital anomalies, limb defects, overgrowth syndromes, or similar complaints in any of their family members.

Assessment of force control improvement induced by sinusoidal vibrotactile stimulation in dominant and non-dominant hands

Vibrotactile stimulation has been shown to improve sensorimotor integration in the central nervous system, thereby enhancing motor performance in several conditions. Here we aim to address two questions: (1) Would lateral asymmetries yielding handedness influence the force control improvement induced by sinusoidal vibrotactile stimulation? (2) Does the force control improvement depend on finding an optimum stimulus intensity? Eleven participants performed a visually guided force-matching task, while different intensities of sinusoidal vibrations were applied to the index finger skin. Tasks consisted of abductions of the index fingers of dominant and non-dominant hands at 5% of their maximal voluntary contractions. The force coefficient of variation (CoV) in the condition without vibration was used as the reference (control) for later comparison with five vibration intensities. Also, force CoV in the control condition was compared with those obtained from the optimal vibration selected either from both hands or from a single hand (the one that started the experiment). Despite the known sensory asymmetries in cortical and spinal circuits, handedness did not significantly influence the improvement of force control induced by sinusoidal vibrotactile stimulation during low-intensity contractions. Moreover, there was a significant reduction in force variability irrespective of the criteria used to select the vibration intensity. These findings add to the current knowledge on the effects of sinusoidal vibrotactile stimulation on force control and have potential implications for the development of wearable motor enhancer devices.

Vibration Alert to the Brain: Evoked and Induced MEG Responses to High-Frequency Vibrotactile Stimuli on the Index Finger of Dominant and Non-dominant Hand.

Background: In recent years, vibrotactile haptic feedback technology has been widely used for user interfaces in the mobile devices. Although functional neuroimaging studies have investigated human brain responses to different types of tactile inputs, the neural mechanisms underlying high-frequency vibrotactile perception are still relatively unknown. Our aim was to investigate neuromagnetic brain responses to high-frequency vibrotactile stimulation, using magnetoencephalography (MEG).Methods: We measured 152-channel whole-head MEG in 30 healthy, right-handed volunteers (aged 20–28 years, 15 females). A total of 300 vibrotactile stimuli were presented at the tip of either the left index finger or the right index finger in two separate sessions. Sinusoidal vibrations at 150 Hz for 200 ms were generated with random inter-stimulus intervals between 1.6 and 2.4 s. Both time-locked analysis and time-frequency analysis were performed to identify peak responses and oscillatory modulations elicited by high-frequency vibrations. The significance of the evoked and induced responses for dominant and non-dominant hand stimulation conditions was statistically tested, respectively. The difference in responses between stimulation conditions was also statistically evaluated.Results: Prominent peak responses were observed at 56 ms (M50) and at 100 ms (M100) for both stimulation conditions. The M50 response revealed clear dipolar field patterns in the contralateral side with significant cortical activations in the contralateral primary sensorimotor area, whereas the M100 response was not as prominent as the M50. Vibrotactile stimulation induced significant suppression of both alpha (8–12 Hz) and beta (20–30 Hz) band activity during the mid-latency period (0.2–0.4 s), primarily in sensorimotor areas contralateral to the stimulation side. In addition, a significant alpha enhancement effect in posterior regions was accompanied with alpha suppressions in sensorimotor regions. The alpha suppression was observed in a broader distribution of cortical areas for the non-dominant hand stimulation.Conclusion: Our data demonstrate that high-frequency tactile vibrations, which is known to primarily activate Pacinian corpuscles, elicit somatosensory M50 and M100 responses in the evoked fields and induce modulations of alpha and beta band oscillations during mid-latency periods. Our study is also consistent with that the primary sensorimotor area is significantly involved in the processing of high-frequency vibrotactile information with contralateral dominance.

Effect of strengthening exercises in Hirayama disease: a case study

Background/AimsThe effects of strengthening exercises in patients with Hirayama disease are not well documented. This case study examined the effect of strengthening exercises on hand functions in a patient with Hirayama disease.MethodsAn 18-year-old man with weakness in the right hand was given a hand-function strengthening programme consisting of 40 minutes of exercises, which were performed 5 days a week over an 8-week period. The patient used theraputty, a gel ball, finger dexterity board, gym kit and hand grip exerciser. The effects of the programme were evaluated using manual muscle testing, a hand-held dynamometer, pinchometer and the Minnesota Manual Dexterity Test.ResultsThe patient's manual muscle testing grades improved following the strengthening programme. Results from the Dynamometer, pinchometer and Minnesota Manual Dexterity Test objectively exhibited increased muscle strength and improved hand functions.ConclusionsStrengthening exercises are effective in alleviating muscle weakness and improving hand functions associated with Hirayama disease.

Precise quantification of extravascular fluid and oedema severity in heart failure

Abstract Early diagnosis of heart failure (HF) severity and prediction of acute decompensation is complicated due to the absence of specific symptoms and objective measurable criteria. Here we present a new indicator of the HF severity based on the soft tissue optical imaging in nail-fold capillaries. Material and methods One hundred and twenty nine (129) adults we enrolled in the study, including 79 patients with NYHA I–III functional classes of HF, and 50 healthy volunteers without history or risk factors for cardiovascular disease. All patients with HF underwent a standard clinical and laboratory examination including comprehensive echocardiography for evaluation of heart chambers and intracardiac haemodynamics, systolic and diastolic function of the left ventricle (LV). The left ventricular ejection fraction (LVEF) was estimated by the ratio of LV stroke volume (Doppler calculation of aortic systolic flow) to the LV end-diastolic volume (Simpson's method) according to the ESC recommendations for management of patients with HF. Vital digital capillaroscopy (VDC) of the nail-fold was performed in all patients and healthy volunteers following a 12-hour overnight fasting in a temperature-controlled room in the seated position and the left arm at heart level. Nail-fold capillaries and pericapillary tissue were assessed on fingers of the left hand gently fixed into the device using a digital capillaroscope equipped with a high speed CCD-camera. We used VDC to measure the linear size (in mm) of perivascular zone (PZ) around nail-fold capillaries. Two-photon tomography with fluorescence lifetime imaging (FLIM) was used to investigate PZ composition. Results We observed significant differences in the linear size of the PZ in patients with HF and control group. The absolute dimension of PZ strongly correlated with the functional class of HF and outperformed standard echocardiographic parameters used in evaluation of patients. Only in patients with moderate-severe HF (functional class III) there was an echocardiographic evidence of systolic LV dysfunction with reduced LVEF (42±12%). This was confirmed by the distribution of subjects in the control and HF groups by the PZ size and bivariate density analysis. FLIM confirmed that the PZ size is mostly determined by accumulation of extravascular free water. Results The simple measurement of the linear size of nail-fold perivascular zone has high sensitivity and specificity in identification of patients with different NYHA classes of HF. The positive predictive value of this parameter exceeds that for all other non-invasive parameters, namely, LVEF. Dimension of the PZ is determined by amount of extravascular free water as confirmed by the fluorescence lifetime imaging. This approach could be of interest for differential diagnosis of HF and monitoring its treatment, providing important possibility to predict HF decompensation with very early diagnosis of the interstitial fluid retention. Patient distribution: PZ size and LVEF Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Russian Science Foundation

Dermatophytes, dermatophytosis in the Caribbean and potential for herbal therapy

Introduction: Dermatophytes are a group of morphologically related keratinophilic fungi that invade keratinized tissue (skin, hair, and nails) of humans and warm-blooded animals to produce clinical lesions (dermatophytosis). Clinical lesions are traditionally divided according to the site infected, namely, scalp (tinea capitis), feet (tinea pedis, commonly called “athletes’ foot”), groin, inner thighs, or buttocks (tinea cruris, commonly called “jock itch”), beard (tinea barbae), hands (tinea manuum, toe nails or finger nails (tinea unguium, also called onychomycosis), face, non-bearded area (tinea faciei) and other parts of the body, such as arms, abdomen, or legs (tinea corporis). Dermatophytosis is common world-wide and is caused by species of three genera of dermatophytes, namely Microsporum, Trichophyton, and Epidermophyton. This study presents an update of ecology of different species of dermatophytes and epidemiology of infections caused by them in the Caribbean. Possibility of herbal therapy of these infections as an alternative treatment is also dealt with.
 Methods: A thorough search of literature was made using PubMed, MEDLINE, Biomed Lib, Med Facts, and different sets of key words, viz. dermatophytes, tineas in Caribbean, occurrence in animals, soil etc.
 Results: It was revealed that incidence of dermatophytic infections and their epidemiologic characteristics depend on social, geographic, and environmental factors and may change with passage of time. For instance, prior to year 2000, the major cause of tinea capitis in North America for 100 years was Microsporum canis followed by M. audouinii; Since 1950 Trichophyton tonsurans has advanced from Mexico and the Caribbean to be currently a major cause of tinea capitis in North America. The two dermatophytes Microsporum gypseum and M. fulvum, and several Chrysosporium species have been frequently isolated form soils in different countries in the Caribbean.
 Conclusions: There is almost complete lack of information on human infections due to dermatophytes in several Caribbean countries. The preponderant occurrence of M. fulvum in Anguilla soils with comparatively rare isolation of M. gypseum is a significant observation. The need for further epidemiological studies on dermatophyosis in the Caribbean countries cannot be overemphasized.

Quantitative analysis of metacarpophalangeal joints during active flexion using four-dimensional computed tomography

BackgroundThe metacarpophalangeal joint has a unique morphology with a high degree of freedom. However, few studies have analyzed the kinematics of fingers owing to the rapid movement of the small bones involved. The in-vivo kinematics of metacarpophalangeal joints were analyzed by four-dimensional computed tomography (4DCT) and associated with its morphology. MethodsThe flexion motion of the fingers of bilateral hands in 10 volunteers were examined using 4DCT. Iterative surfaces were registered to trace the surface of the proximal phalanges with respect to metacarpals. Rotation angles were calculated using Euler/Cardan angles. FindingsIn the index finger, the proximal phalange supinated to a maximum flexion of 40° and then pronated, and its range of rotation was larger than the previous reports. In the other fingers, the proximal phalanges continued to supinate during flexion. The helical axis of the proximal phalange passed a point extremely close to the center point of bilateral condyles, and it moved toward the proximal and palmar directions until the middle stage of flexion and toward the proximal and dorsal directions during the late stage of flexion. The translation of the rotation axis was larger in the ring and little fingers. InterpretationThe rotation in the index finger was larger than previously reported. The helical axes moved in the dorsal direction and proximally during the latter phase of the flexion. These results can be employed to better understand the causes of implant failure of the metacarpophalangeal joints.

Hypothenar Island flap: a safe and excellent choice for little finger defects

Objective The aim was to evaluate the functional and cosmetic results of hypothenar island flap for the reconstruction of little finger defects and to assess them by follow-up. Background Reconstruction of soft-tissue defects of little finger of the hand needs a single-stage procedure that can provide well-vascularized coverage at the earliest stage to give the best functional result. Patients and methods This follow-up study that included 19 patients (13 men and six women) was carried out in the Plastic and Reconstructive Surgery Departments of Menoufia University and Helmia Military Hospital from October 2017 to October 2019, with assessment by a follow-up period of 12 months and physiotherapy. All the patients studied had the hypothenar island flap for coverage of the defects. The defects were due to postblunt trauma in three cases, post-burn in three cases, and post-sharp trauma in 13 cases. The largest flap was 20 × 15 mm2. The donor site was directly closed in all cases. Results The overall results were satisfactory regarding the function and appearance without major complications according to patient and doctor satisfaction. Regarding flap course and survival, 14 (73.7%) flaps passed uneventfully, five (26.3%) flaps suffered from venous congestion, five congested flaps survived without total loss and only partial loss and thus we had 19 (100%) survived flaps. Conclusion Hypothenar island flap is a reliable and versatile source for coverage of soft-tissue defects of little finger of the hand.

Peri-operative swelling of fingers: A prospective observational study.

In most Dutch hospitals, because of putative peri-operative swelling of the fingers, patients must remove rings before entering the operating theatre. If this proves impossible, destructive methods for removal may be required. For some patients, this might be too radical, as the risk of wearing rings may not be in proportion to the economic and emotional damage to the patient. The objective of this study was to determine whether peri-operative swelling of fingers occurs in elective surgery patients. A prospective observational study. University Medical Centre. Five groups of patients: major cardiothoracic surgery, major noncardiothoracic surgery, nonmajor surgery with a minimum of one overnight stay, nonmajor surgery without overnight stay and surgery under intrathecal anaesthesia. Finger swelling, as measured by the circumference of the first phalanx of the middle and ring fingers of both hands, pre-operatively and at 3, 24 and 48 h postsurgery, using a roller tape with one winding and 20-g weights in a custom-made frame. One hundred and forty-eight patients were enrolled. Peri-operative swelling reached statistical significance in all groups and was most prominent in major cardiothoracic and noncardiothoracic surgery (maximum increases in circumference were 10.6 and 7.3%, respectively). In all groups, maximal swelling was observed 24 h postsurgery. Peri-operative swelling of fingers is a common phenomenon, which is related to the extent of the surgical procedure. Netherlands Trial Register NL8066.

EFFECTIVENESS OF HAND HYGIENE IN REDUCING BACTERIAL FLORA IN HEALTH CARE WORKERS-A STUDY OF IMPACT

Introduction: Hand hygiene is simplest, most effective and least expensive tool to prevent health care worker associated infection. The compliance among HCW is low due to various reasons leading to increased morbidity and mortality in Healthcare associated infection (HAI). Proper hand hygiene significantly reduces bacterial flora and HAI. The study was planned with the aim to know the pattern of microbial flora and its drug resistance and effectiveness of hand hygiene in reducing bacterial load on hands of health care workers. Material and Methods: Both hand finger imprints of 50 participants were taken on Blood agar before and after hand hygiene. The plates were incubated 24-48 hours at 37°C.Colony count was done. Bacteria were identified by their colony characteristics and biochemical reactions. AST was performed as per CLSI 2019 guidelines. Results: 90-99% reduction in bacterial colony count after hand hygiene was seen in majority of participants Mixed growth was seen in ten samples. Micrococcus was most common organism isolated in twenty-four samples, followed by diptheroids in sixteen samples, Coagulase negative staphylococcus (CoNS) in fourteen samples and Staphylococcus aureus in six samples .Three CoNS and four Staphylococcus aureus were Methicillin resistant. Gram negative bacilli isolated were Klebsiella species, Pseudomonas species and Escherichia Coli each in two samples respectively One Escherichia Coli was ESBL producer. All the GNB were sensitive to carbapenem. After performing hand hygiene micrococcus was isolated from four sample, diptheroids from three and CONS from one sample. Staphylococcus aureus and GNB were not found after hand hygiene Conclusion: HCW hands are colonized with bacteria. Proper hand hygiene technique awareness and its compliance significantly reduce bacterial load and decrease HAI.

VP04.17: Acitretin embryopathy due to acitretin intake during the first and second trimesters of pregnancy

Acitretin is an aromatic retinoid analog of vitamin A used to treat severe forms of psoriasis and disorders of keratinisation. It is contraindicated during pregnancy because of its teratogenic potential. Acitretin embryopathy is a rare teratogenic disorder due to acitretin exposure during the 1st trimester, with a risk of fetal malformations of nearly 20% involving the central nervous system, various craniofacial and ear abnormalities, as well as cardiac, upper and lower limbs defects. Only a few cases of newborns with exposure to acitretin in the 1st trimester and anomalies compatible with this syndrome are known. We describe the case of a 24-year-old woman with epidermolytic hyperkeratosis, taking daily acitretin 25mg for many years. Pregnancy was unplanned, discovered at 18 weeks of gestation and very poorly monitored. She missed several appointments and inadvertently maintained acitretin intake until 30 weeks of pregnancy. When referred to our consultation at 32 weeks a fetal scan was requested. Ultrasound at 34 and 36 weeks exposed craniofacial malformations including prominent frontal bone, abnormal ears, low-set ears, low nasal bridge and absent hand finger. Fetal echocardiogram was normal. A female neonate was delivered at term with 2,515g and an Apgar score of 9/10/10. Evaluation at birth confirmed craniofacial dysmorphism with microcephaly, craniosynostosis, sinking of metopic sutures with prominent frontal bone, low nasal bridge, microphthalmia, hypertelorism, low-set ears, high-arched palate and limb defects with elbow arthrogryposis, absent 1st finger in both hands and 4th and 5th finger foot syndactyly. Brain MRI showed no endocranial abnormalities. These findings are in accordance to the spectrum of defects described in the literature for acitretin embryopathy. This case emphasises the extreme precaution that is needed with the use of teratogenic drugs in women of childbearing age and the importance of mandatory use of an effective contraception.