Knuckle Pads Treatment & Management

  • Author: Cheryl J Barnes, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 17, 2012
 

Medical Care

Neither medical nor surgical interventions for knuckle pads are very effective. Eliminating the source of mechanical or repetitive trauma may improve the lesions. Wearing protective gloves or changing occupation may be necessary. Intralesional injections of corticosteroids or fluorouracil may reduce the size of the lesions.[23] Lesions caused by biting or sucking may require a psychiatrist to treat the underlying psychological problem. A cast or splint placed temporarily on the involved areas of the hand may aid in reducing the lesion. Application of silicone gel sheeting has had limited success.[24] Applications of keratolytics, such as salicylic acid or urea, have helped to soften and even reduce the lesions. Radiation therapy and application of solid carbon dioxide have been reported to be of some help in selected cases.

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Surgical Care

Surgical intervention may be indicated if knuckle pads cause a functional problem. Recurrence after surgery is likely, especially if the trauma that caused the initial knuckle pad is not eliminated. Scar or keloid formation may result from surgical intervention. Tendon tethering, another surgical complication, occurs only if the joint space or capsule is accidentally cut with damage to the tendon in the attempt to remove the knuckle pad.[25]

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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

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.

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

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and 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, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

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

Disclosure: Nothing to disclose.

References

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  12. Du ZF, Wei W, Wang YF, Chen XL, Chen CY, Liu WT, et al. A novel mutation within the 2B rod domain of keratin 9 in a Chinese pedigree with epidermolytic palmoplantar keratoderma combined with knuckle pads and camptodactyly. Eur J Dermatol. Sep-Oct 2011;21(5):675-9. [Medline].

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  15. Wooldridge WE. Four related fibrosing diseases. When you find one, look for another. Postgrad Med. Aug 1988;84(2):269-71, 274. [Medline].

  16. Ritter SB, Petersen G. Esophageal cancer, hyperkeratosis, and oral leukoplakia. Occurrence in a 25-year-old woman. JAMA. Apr 19 1976;235(16):1723. [Medline].

  17. Leonard NJ, Krol AL, Bleoo S, Somerville MJ. Sensorineural hearing loss, striate palmoplantar hyperkeratosis, and knuckle pads in a patient with a novel connexin 26 (GJB2) mutation. J Med Genet. Jan 2005;42(1):e2. [Medline].

  18. Koba S, Misago N, Narisawa Y. Knuckle pads associated with clubbed fingers. J Dermatol. Dec 2007;34(12):838-40. [Medline].

  19. Pierard GE, Lapiere CM. Phenytoin dependent fibrosis in polyfibromatosis syndrome. Br J Dermatol. Mar 1979;100(3):335-41. [Medline].

  20. Glicenstein J, Costa R. [Pachydermodactyly: a report of two cases]. Chir Main. Aug 2004;23(4):205-7. [Medline].

  21. Verbov J. Letter: Pachydermodactyly: a variant of the true knuckle pad. Arch Dermatol. Apr 1975;111(4):524. [Medline].

  22. Bettoni L, Bani L, Airò P. Rheumatoid nodules: the importance of a correct differential diagnosis. Eur Ann Allergy Clin Immunol. Jun 2011;43(3):95-6. [Medline].

  23. Weiss E, Amini S. A novel treatment for knuckle pads with intralesional Fluorouracil. Arch Dermatol. Nov 2007;143(11):1458-60. [Medline].

  24. Quinn KJ. Silicone gel in scar treatment. Burns Incl Therm Inj. Oct 1987;13 Suppl:S33-40. [Medline].

  25. Addison A. Knuckle pads causing extensor tendon tethering. J Bone Joint Surg Br. Jan 1984;66(1):128-30. [Medline].

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