Erythematous Papules on Dorsum of Both Hands


Am Fam Physician. 2017 Jun 15;95(12):803-804.

An otherwise healthy 24-year-old student presented with a three-month history of multiple asymptomatic papules on the extensor surfaces of both hands. She had no history of trauma, allergen exposure, or repetitive friction to her hands. She had no history of a similar rash.

Physical examination revealed confluent, grouped, hyperkeratotic, flat-topped, erythematous papules overlying the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints on the dorsum of both hands (Figure 1).

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Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Allergic contact dermatitis.

B. Gottron papules.

C. Knuckle pads.

D. Lichen planus.

E. Psoriasis.


The answer is B: Gottron papules. Gottron papules are erythematous, flat-topped, hyperkeratotic papules on the dorsal interphalangeal or metacarpophalangeal joints, elbows, or knees. They are a typical cutaneous feature of dermatomyositis.1,2 Dermatomyositis is an id

Author disclosure: No relevant financial affiliations.

Address correspondence to Hei Sung Kim, MD, PhD, at Reprints are not available from the authors.


show all references

1. Goldsmith LA, ed. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, NY: McGraw-Hill; 2012....

2. Maan MA, Akhtar SJ, Haque H. Dermatomyositis. J Pakistan Assoc Dermatol. 2008;18:33–43.

3. Nenoff P, Woitek G. Images in clinical medicine. Knuckle pads. N Engl J Med. 2011;364(25):2451.

4. Wolff K, Johnson RA, Fitzpatrick TB. Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology. 6th ed. New York, NY: McGraw-Hill; 2009.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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Apr 15, 2018

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