September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
Happy New Year and welcome to a new decade.
This 18 year old lady was referred with thickened lesions arranged symmetrically over the backs of her hands, which had been present from a young age. The lesions were asymptomatic and there had been no history of trauma. There was no personal or family history of skin disease and the patient was otherwise well.
Multiple, well-circumscribed, firm plaques/nodules over the proximal interphalangeal joints of both hands.
What is the diagnosis?
The lesions are knuckle pads.
Most knuckle pads are idiopathic or related to repetitive trauma, the latter are sometimes referred to as pseudo knuckle pads. There is a strong association with other fibromatoses such as palmar fibromatosis (Dupuytren's contracture). Some cases of knuckle pads are familial and may be part of a syndrome, eg, the Bart-Pumphrey syndrome (BPS), which is an autosomal-dominant disorder characterised by hearing loss, leukonychia, knuckle pads and palmoplantar keratoderma.
Onset is usually between 15-30 years of age; however, lesions typically develop slowly and asymmetrically and may not present significant cosmetic problems for several years.
Most lesions occur over the proximal interphalangeal rather than the metacarpophalangeal joints or the distal interphalangeal joints.
There is no specific treatment. Intralesional steroids or cryotherapy are ineffective, and recurrence and keloidal scarring are common following surgery.
Refer to the chapter on knuckle pads for more information.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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