REPORT OF A CASE
A 46-year-old white man presented with a 10-year history of asymptomatic papules and plaquelike thickenings over the proximal interphalangeal joints. He worked as a mechanic and had no other medical problems except hypertension.
Physical examination disclosed firm, skin-colored papules and plaques, varying from 5 to 10 mm in diameter, over the proximal interphalangeal joints of the third and fifth fingers on the left hand and index through fifth fingers on the right hand (Figure 1).
He had no plantar or penile lesions. The patient also had nodular thickenings of the palms consistent with Dupuytren's contractures (Figure 2). A punch biopsy specimen of a papule is shown in Figures 3 and 4.
What is your diagnosis?
DIAGNOSIS:
Knuckle pads (heloderma).
HISTOPATHOLOGIC FINDINGS
A punch biopsy specimen of a papule revealed an acanthotic epidermis with compact hyperkeratosis overlying it. In
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