Presentation
Practice Points Acrokeratoelastoidosis presents as small, firm, translucent, linear papules on the ventral-dorsal palmoplantar junction. [mdedge.com]
We present a case of an otherwise healthy 36-year-old woman presenting with bilateral knuckle pads located at the dorsal aspect of the proximal interphalangeal joints. No predisposition to a specific musculoskeletal disorder was noted. [jultrason.pl]
On ultrasound, knuckle pads present as subcutaneous hypoechogenic nodular thickenings. These lesions have a low to intermediate signal intensity on T1-WI and T2-WI MRI. [biblio.ugent.be]
On ultrasound, knuckle pads present as subcutaneous hypoechogenic nodular thickenings localized over the dorsal aspect of the MCP or PIP joint. They have a typical dome shape with irregular borders. [jbsr.be]
Gastrointestinal
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Bulimia
These are more likely to be callosities developing from repetitive pressure or friction, for example, occupational, sporting, finger sucking/chewing, or bulimia nervosa. [dermnetnz.org]
Patients with bulimia who use their knuckles or fingers to induce emesis sometimes develop fibrotic papules resembling knuckle pads. [8] Some cases of knuckle pads are familial. [emedicine.medscape.com]
[…] plumbers, tailors, textile workers), sports/activity related (boxers, surfers, football players, video game enthusiasts, marble players), or are associated with psychiatric disturbances giving rise to repetitive compulsive behavior (biting/chewing, bulimia [dermatologyadvisor.com]
Ears
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Hearing Impairment
Affiliated tissues include skin, and related phenotypes are sensorineural hearing impairment and subcutaneous nodule Disease Ontology : 12 An autosomal dominant disease that is characterized by leukonychia, wart-like skin growths, palmoplantar keratoderma [malacards.org]
A deletion involving the connexin 30 gene in nonsyndromic hearing impairment. N Engl J Med 2002 ; 346 : 243 –9. Lerer I, Sagi M, Ben-Neriah Z, Wang T, Levi H, Abeliovich D. [jmg.bmj.com]
Skin
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Blister
Differential Diagnosis (Other conditions with similar appearance) Abscess Blister Soft tissue tumor Psoriasis Verrucae/Wart Diagnosis Key Points *Diagnosis based on skin appearance *In rare cases, testing may be required to rule out other conditions Calluses [ozarkderm.com]
[…] pustulosis Generalized pustular psoriasis of Zumbusch Lingua geographica Psoriatiform keratosis Infantile acropustulosis Darier's disease Porokeratosis Acrokeratoelastoidosis Pityriasis rubra pilaris Glucagonoma syndrome Acrodermatitis enteropathica Blistering [atlases.muni.cz]
Musculoskeletal
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Heberden's Node
The differential diagnosis includes Bouchard and Heberden’s nodes of osteoarthritis, rheumatoid nodules, gouty tophi and giant cell tumor of the tendon sheaths [ 1 ]. [jbsr.be]
[…] in an area of trauma) – verrucae (papules and plaques with a rough verrucal surface, and punctate black dots representing thrombosed vessels) – rheumatoid nodules (dermal nodules overlying extensor joints in patients with rheumatoid arthritis [RA]) – Heberden’s [dermatologyadvisor.com]
The differential diagnosis of KP includes other subcutaneous nodules like rheumatoid nodules, gouty tophi, Bouchard's and Heberden's nodes, synovial cysts, tumors (e.g. giant cell tumor of the tendons sheats, neurofibromas) or retained foreign bodies [ncbi.nlm.nih.gov]
nodes Scleroderma, morphea Diffuse scleroderma Localized scleroderma, morphea Lichen sclerosus et atrophicus Pachydermoperiostosis Eosinophilic fasciitis Fibromatosis Infantile digital fibromatosis (inclusion body fibromatosis) Intravascular fasciitis [atlases.muni.cz]
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Morning Stiffness
She had no morning stiffness, no paraesthesia and no pain during the night or other signs for inflammatory or mechanical pain. [ncbi.nlm.nih.gov]
Neurologic
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Confusion
However, there are several other conditions that may cause confusion including granuloma annulare, pachydermodactyly, rheumatoid nodules, and synovitis resulting in swollen joints. [dermnetnz.org]
Several conditions can be confused with Knuckle pads. We describe a case of a 47-years-old man who developed multiple bilateral roundish nodules located in the skin over the dorsal and lateral interphalangeal joints in both hands. [pubfacts.com]
Treatment
There is no consistently effective treatment, but knuckle pads have been reported to resolve spontaneously in children. [scholars.northwestern.edu]
Solid carbon dioxide treatment has also been shown to decrease lesion size, but this treatment also can be quite painful. [dermatologyadvisor.com]
The patient previously used over-the-counter topical wart removal treatment and topical salicylic acid with minimal improvement. [mdedge.com]
Treatment *Goal of treatment is to control and lessen symptoms *Prevention of friction is the primary treatment *Does not generally require attention by health care professionals OTC Options: Moisturizers, emery boards, pumice stones, shoe inserts The [ozarkderm.com]
"A Novel Treatment for Knuckle Pads With Intralesional Fluorouracil". Arch Dermatol. 143 (11): 1447–1462. doi : 10.1001/archderm.143.11.1458. PMID 18025384. [en.wikipedia.org]
Prognosis
They have been reported in young children who bite and suck their fingers. [25] More commonly, knuckle pads are observed in adults older than 40 years. [14] Prognosis Little morbidity is associated with knuckle pads as they typically are asymptomatic. [emedicine.medscape.com]
Etiology
To our knowledge, this is the first reported case of knuckle pads with cracking of the knuckles as the possible etiology. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. [onlinelibrary.wiley.com]
The etiology of KPs may be idiopathic or genetic, but KPs are usually acquired in response to repetitive frictional pressure and trauma. [dermatologyadvisor.com]
"Knuckle pads: does knuckle cracking play an etiologic role?". Pediatr Dermatol. 17 (6): 450–2. doi : 10.1046/j.1525-1470.2000.01819.x. PMID 11123776. [en.wikipedia.org]
Knuckle pads: does knuckle cracking play an etiologic role? Pediatr Dermatol 2000;17:450. [wikidoc.org]
Similar to calluses, acquired forms are often a response to repetitive trauma and friction; many authors designate these lesions pseudo-knuckle pads. [3] Etiology Knuckle pads may be idiopathic; however, they are often of the pseudo-knuckle pad variety [emedicine.medscape.com]
Epidemiology
"Epidemiological and structural findings supporting the fibromatous origin of dorsal knuckle pads" J Hand Surg [Br] 16 (1991):237-9 abstract. [dupuytren-online.info]
A role for insulin resistance and resultant hyperinsulinemia triggering insulinlike growth factor to stimulate keratinocyte and fibroblast proliferation was suggested. [24] Epidemiology Frequency Knuckle pads are a common occurrence. [emedicine.medscape.com]
Epidemiological and structural findings supporting the fibromatous origin of dorsal knuckle pads. J Hand Surg Br 1991;16:258–62. Reilly RM1, Stern PJ, Goldfarb CA. A retrospective review of the management of Dupuytren’s nodules. [racgp.org.au]
Pathophysiology
Pathophysiology KPs grow over a period of months to years, and usually do not all appear at once, but rather appear sequentially. Of interest, they also occur frequently in large apes that have a tendency to walk on their knuckles. [dermatologyadvisor.com]
However, knuckle pads have been observed since the Renaissance era; Michelangelo's statue of David demonstrates knuckle pads (Florence, Italy) as do his statues of Moses (Rome, Italy), Victory (Florence, Italy), and Giuliano de Medici (Rome, Italy). [2] Pathophysiology [emedicine.medscape.com]
DC shares a common inheritance mode, predisposing factors, comorbidities, pathophysiology, and evolution with Ledderhose disease, Garrod knuckle pads, and Peyronie disease. [pubfacts.com]
Prevention
[…] minus' sign Virchow -triad Use Parentheses water AND (cup OR glass) Add an asterisk (*) at end of a word to include word stems Neuro* will search for Neurology, Neuroscientist, Neurological, and so on Use quotes to search for an exact phrase "primary prevention [read.qxmd.com]
Treatment *Goal of treatment is to control and lessen symptoms *Prevention of friction is the primary treatment *Does not generally require attention by health care professionals OTC Options: Moisturizers, emery boards, pumice stones, shoe inserts The [ozarkderm.com]
Prophylactic dermatofasciectomy has also been advocated by some to prevent recurrence following surgical removal of KPs. [dermatologyadvisor.com]
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