Knuckle pads are hard, calloused skin lesions that develop on the knuckles due to repetitive trauma or pinching. They are often cosmetic and can be treated with corticosteroid injections or surgery if they persist. The cause is unknown but is associated with Dupuytren’s contracture and a genetic component.
Knuckle pads are round, hard, calloused skin lesions that develop on the central knuckle or distal knuckle located near the fingertip. These pads are produced by a thickening and hardening of the epidermis, the topmost layer of the skin. They are often referred to as heloderma because the pads look like the scaly skin of a Gila monster.
Benign and typically painless, knuckle pads usually do not impede movement of the fingers. The main problem with these bearings is cosmetic. The knuckle pads are quite noticeable due to their size and because the appearance of the pads is sometimes a shade lighter than your normal skin tone. The pads can be as small as 0.1 mm (3 inches) or as large as 0.8 mm (20 inches) and cover the entire knuckle.
The exact cause of this skin condition is unknown. Knuckle pads are associated with repetitive trauma to the knuckles or pinching the knuckles following an injury or insect bite. They are often found on the hands of boxers and people who engage in physical work that often traumatize the fingers. Children are prone to this condition as they are more likely to pinch themselves from a wound or bite.
Knuckle pads are sometimes found on people with bulimia who use their fingers or knuckles to induce vomiting. This skin problem is also strongly associated with Dupuytren’s contracture, a condition in which scar tissue develops on the palm of the hand. These pads are also associated with camptodactyly, a condition in which the toes become progressively and permanently bent. The propensity to develop these pads tends to run in families, suggesting that there is a genetic component to the manifestation of this condition.
These skin lesions sometimes shrink on their own and disappear over time. This is often true when the knuckle pads have been caused by trauma or a pinch and these issues are resolved. If heloderma persists, there are a few treatment options. Knuckle pads can be treated with corticosteroid injections, which tenderize the pads and gradually reduce their size.
When this condition does not respond to steroid injections and does not reduce on its own, outpatient surgery is a last resort. During the surgery, local anesthesia is used to numb the finger and then the thickened, superficial skin is cut. Great care must be taken after surgery to prevent trauma to the wound and prevent another tampon from growing over the surgical site.
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