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Knuckle Pads

  • Author: Cheryl J Barnes, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Jul 14, 2016


Knuckle pads are benign, asymptomatic, well-circumscribed, smooth, firm, skin-colored papules, nodules, or plaques, located in the skin over the dorsal aspects of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. A history of repetitive trauma related to sports or occupation is often present.

Garrod first described knuckle pads in the medical literature in 1893,[1] but knuckle pads have been observed since the Renaissance era. Allison et al shows a photo of Michelangelo's statue of David displaying knuckle pads (Florence, Italy) as well as his statue of Moses (Rome, Italy), Victory (Florence, Italy), and Giuliano de Medici (Rome, Italy).[2] The name knuckle pad seems to be a misnomer because in most reported cases, lesions occur over the proximal interphalangeal (PIP) joint, not over the knuckles.



Knuckle pads may be idiopathic, genetic, acquired as a response to repetitive trauma, or associated with several other acquired conditions.




United States

Knuckle pads are a common occurrence. Measurement of prevalence of knuckle pads is difficult because patients are asymptomatic and do not seek medical attention for them.


Knuckle pads were noted in about 9% of subjects in one survey. Patients with Dupuytren contracture are four times as likely as the general population to have knuckle pads.


No racial predilection is associated with knuckle pads.


Prevalence of knuckle pads is equal for men and women. Even in the presence of Dupuytren contracture, the prevalence of knuckle pads remains equal.


Knuckle pads can present at any age. They have been reported in young children who bite and suck their fingers.[3] More commonly, knuckle pads are observed in adults older than 40 years.



Little morbidity is associated with knuckle pads. Patients typically are asymptomatic, but some patients experience pain and difficulty with hand functioning, including writing, as a result of their condition. Cosmetic issues drive most patients to seek attention for knuckle pads. Spontaneous resolution can occur, especially if an inciting repetitive injury is identified and eliminated. In most cases, knuckle pads persist indefinitely with little change.

Contributor Information and Disclosures

Cheryl J Barnes, MD Dermatologist, McIntosh Clinic, PC

Cheryl J Barnes, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.


Loretta Davis, MD Professor, Department of Internal Medicine, Division of Dermatology, Medical College of Georgia

Loretta Davis, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Gregory J Raugi, MD, PhD Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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Knuckle pad over the proximal interphalangeal joint.
Multiple knuckle pads on various joints of the hand.
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