Finger pebbles (Huntley’s papules)

Finger pebbles 1
They occur in people over the age of 30, more often in women than in men. A predisposing factor for their development is diabetes mellitus. The pathogenesis is not understood (possibly due to increased collagen production in the presence of hyperglycemia).

Skin examination revealed diffuse xerosis and a rough, sandpaper-like appearance of the finger skin consisting of multiple, small, hyperkeratotic papules grouped in a miniature "cobblestone" pattern on the dorsum of the distal phalanges, more densely over the knuckles and interphalangeal joints. Pruritus is usually absent. A complete examination of the patient may reveal other dermatologic findings often associated with diabetes mellitus (granuloma annulare and necrobiosis lipoidica).

The diagnosis is mainly based on the clinical presentation.

Histologically, finger pebbles are the result of increased collagen in the dermal papillae.

Lab tests:
  • Glycated hemoglobin (A1C) test
  • Blood glucose level

  • Papular mucinosis
  • Knuckle pads

Treatment consists of controlling the underlying disease.