“My fingertips hurt so much, I can't work,” was the tearful complaint of this forty-year-old hairdresser. We looked at her fingertips and there was not a thing to be seen. They were absolutely normal; yet, touching them made her wince. Squeezing them made her scream. What was wrong? Was she malingering? Did she have a neurologic disease?

This was no ordinary case. She had seen a posse of physicians but no one had caught the criminal. The neurologists gave her a good bill of health and so did the psychiatrist. Her family physician had no special insight nor was the report of the peripheral vascular specialist helpful. Several dermatologists had provided no enlightenment.

Well, first things first. What was the exact history? The problem began last fall as marked sensitivity of the lateral side of the tip of the right fourth finger. Shortly thereafter, the medial tips of both thumbs were similarly affected. Eventually, all of the fingers became involved to a greater or lesser degree. Inflammatory changes were absent, but exquisite tenderness to touch continued and pressure on the fingertips always induced pain. There were no other sensory changes and her toes were not affected.

Her past history was noncontributory. Neither she nor anyone in her family had experienced neurologic or psychiatric problems. There was no history of skin disease or diabetes mellitus. She had worked for many years as a hairdresser, but knew of no new contactants at work or home.