Knuckle Pads: Heloderma…

Knuckle Pads are also referred to as Heloderma, Athlete’s Nodules, Running/Nike Nodules, Subcutaneous Fibroma, Keratosis Supracapitularis, Discrete Keratoderma, Tylositas Articuli and Garrod pads.  Knuckle Pads are well-defined, round, plaque-like fibrous thickenings that develop on the extensor aspects of the proximal interphalangeal joints of the toes and fingers to include the thumbs.  They may develop at any age and grow to about 10-15 mm in diameter over a few weeks or months and are permanent.  They are often flesh colored but may also be brown, with normal or slightly hyperkeratotic epidermal features.  They are derived from the skin and are freely movable over underlying structures.

 

Knuckle Pads are sometimes associated with Dupuytren contracture, clubbing or camptodactylia, which is an irreducible flexion contracture of one or more fingers.  Some cases are inherited and some are related to trauma or frequent knuckle cracking.  Autosomal dominant forms of knuckle pads may experience hearing loss, keratoderma and leukonychia.  Bart-Pumphrey syndrome is due to a GBJ2 mutation and there have been patients with a mutation in keratin 9 with knuckle pads and epidermoytic palmoplantar keratoderma.  It is considered a form of fibromatosis and histologically the lesions are fibromas.

TREATMENT:  Intralesional injections of corticosteroids may be beneficial.  Intralesional treatment with 5-Fluorouracil has also been used with some success.  Keratolytics such as Urea 10-20%, Salicylic acid 6%, and Lactic Acid lotions 5-12% may also be useful.  To read more about Knuckle Pads click HERE, HERE and HERE.