By Gary M. White, MD
Knuckle pads are small nodules that occur over the knuckles.
Knuckle pads are are most common over the PIP joint. They present as multiple nodules which may be smooth or hyperkeratotic. Only a few or all fingers may be affected. The condition is uncommon on the toes but does occur. Onset is usually in childhood.
It is important to exclude repeated trauma that induces calluses over the knuckles. Specific professions that are associated with pseudo-knuckle pads include carpet layers, sheep shearers, and tailors. Obsessive-compulsive behaviors that involve rubbing or chewing on the knuckles should also be excluded. There are rare genetic syndromes that are associated.
Any significant friction, e.g., knuckle push-ups, rubbing, etc., should be minimized. A trial of a topical steroid for 1 month may be tried. Topical keratolytics (e.g., ammonium lactate) may help some if there is significant epidermal hyperkeratosis. However, if the majority of change is dermal, no treatment is usually beneficial. Intralesional injection is usually not warranted and excision, with the potential for much scarring, is not recommended. If onset is in childhood, spontaneous resolution by adulthood may occur.
Knuckle pads are less common on the toes.
Dermatology Online Journal, 19(5)
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