Knuckle pads

Abstract

Knuckle pads are firm, well-defined plague like lesions that most often appear over the proximal interphalangeal joints of hands. They develop gradually over months to years and then may persist permanently. Knuckle pads usually appear in children or adolescents. They are most often idiopathic and sporadic, but may be related to trauma or inherited. A 21-year-old man was admitted to the Department of Dermatology because of the presence of symmetric, sharply defined hyperpigmented and hyperkeratotic cushion-like pads located over proximal interphalangeal joints of both hands. First lesions appeared 2 years ago. The patient was a student and he was not working physically, although he was riding a bicycle regularly and several times daily, as a matter of habit, he interlocked his fingers and then applied a pressure. In patient other fibromatoses such as Ledderhose disease, Peyronie disease orfibrosis of the male breast were not present. Family history for the presence of similar skin lesions was negative. Histology of the lesion demonstrated thickening and hyperkeratosis of the epidermis and oedema of the dermal collagen bundles. Mesotherapy with triamcinolone acetonide was employed. Although the patient did not present with other fibromatoses and the family history for the presence of knuckle pads was negative, the lesions aroused at the age of 19 years, trauma appeared to play a role in their development and the clinical and histological picture was suggestive for knuckle pads. Copyright © 2005 Cornetis.