Knuckle Pads in Dupuytren's Contracture

Knuckle pads can be defined as “keratotic, circumscribed, fibrous growths over the interphalangeal joints on the back of the hand.” Keratotic refers to the growth of cells with keratin, which is a common material in a layer of the skin called the epidermis. Knuckle pads are also described as circumscribed and fibrous, meaning this growth of keratin cells has fibrous (or grainy) tissue and is limited to one area. In this case, the area is just around the knuckle, also known as the interphalangeal joints.

When someone develops an issue with their knuckle pads, it's called a holoderma. This causes a round, raised mass of tissue over any of the three knuckles on the finger: at the base of the finger, mid-way up the finger, or at the top near the nail. People can develop a holoderma at any age and the masses can grow between 1 and 15 millimeters in diameter.

They usually take a few months to worsen and may disappear over time. There still isn’t much known about this phenomenon, but scientists have found a direct connection between holoderma and Dupuytren's Contracture.

Knuckle Pads and Dupuytren's Contracture

Some patients with Dupuytren's contracture may end up with a holoderma. Though rare, in some cases, these can be attached to underlying tendons that assist with extending, or straightening, the fingers.

Most users have normal or thin skin but some may end up with wrinkled skin as a result of a holoderma. A range of people can develop holodermas, such as those who play sports or surf. For this reason, they are often called Athlete's nodules or Surfer's nodules. But still, doctors believe that people with Dupuytren's contracture run a higher risk of having knuckle pads, which is why they are more often referred to as dorsal Dupuytren's nodules.

While nodules on the hands can develop for a range of reasons, it is usually obvious when they are related to Dupuytren's because they tend to pop up very close to or directly on the knuckle(s). 

What we know about knuckle pads

As mentioned earlier, there isn’t much known about knuckle pads or why they occur. So far, here is what has been determined about knuckle pads:

• Knuckle pads more often develop prior to someone experiencing other symptoms of Dupuytren's disease
• Some individuals may end up with calluses surrounding the knuckles due to irritation in the area while using the finger or having it rub up against something
• These pads are known to resolve spontaneously, but they can be unsightly and frustrating for some people in the time it is present
• Some patients report symptoms specific to the knuckle pads, including pain and redness, while others don't have any issues with them being there
• If someone has surgery to remove the mass of cells, it's common for the knuckle pads to come back after a period of time (it may take a year or more)
• These pads are often located centrally over the middle knuckle of the finger
• The same joint may have one or several knuckle pads on the top or side
• The PIP joint (the middle knuckle) is most commonly affected by knuckle pads, but the upper joint (DIP) and lower joint (MCP) may also develop thickened tissue
• This can also impact the base of the thumb, called the IP joint
• Thickened pads can occur even on fingers not affected by Dupuytren's

What Does Science Say?

It's important to know that a holoderma is not exclusive to those suffering from Dupuytren's disease. Someone may develop the condition even if they don't have Dupuytren's contracture. However, those suffering from Dupuytren's contracture are known to be four times more likely to report this associated condition. Current research does not indicate any connection between the presence of a holoderma and more severe Dupuytren's symptoms. So, if you develop a holoderma, you may still only experience a mild case of Dupuytren's that is perfectly manageable with a natural approach such as Dupuytren's contracture cream.