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Want advice on discoloration on knuckles and rough patches around them.

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Practicing since : 2004
Answered : 1073 Questions
I do medical work in Tanzania and for the last few months my knuckles have formed discolored and rough patches around them.

Please see my medical history...


I've noticed these things on my skin which have slowly been forming over the last few months. It is discoloration on the knuckles of my hand. Yes, I have tried washing it off :) Below is a picture

picture: WWW.WWWW.WW
closer: WWW.WWWW.WW

They are slightly rough. It first started on the 3rd knuckle from the left side of my left hand and slowly formed on the other knuckles. I think it is barely starting to form on that same first knuckle on my RIGHT hand now. I also just looked in the mirror and believe the same discoloration is forming on my elbows.

Other medical advice:

I did ask another doctor online and he suggested it was b12 deficiency. I've started taking b12 injections. However I asked a doctor who I now work with, he looked at them and felt them and didn't think it was b12. It was recommended I talk to a hemotologist. So now I'm asking you :)

Posted Tue, 24 Apr 2012 in Skin Hair and Nails
Answered by Dr. Indranil Ghosh 13 hours later
Thanks for posting your query.

Dark knuckles are a common phenomena and seen in many people across all age groups. Mostly, it is due to regular wear and tear sustained by fingers.
Sometimes, actually lead to such an appearance. I have seen your pictures and I agree that they are probably not due to vitamin B12 deficiency. However, it still remains a possibility.
To confirm Vitamin B12 deficiency, I would recommend the following investigations:
•     Complete blood count with peripheral smear
•     Serum B12 levels.
If the blood shows large red cells and/or low B12, then taking injections of vitamin B12 is indicated.

I would like to reassure you that they are not related to your past history of low-grade lymphoma.

Above answer was peer-reviewed by
Follow-up: Want advice on discoloration on knuckles and rough patches around them. 10 minutes later
thank you for your answer. I know this is most likely not a hematological issue, but a friend suggested I go ahead and ask since I'm in a place where it is difficult to get good health care. A follow up question, someone else suggested it might be Acanthosis Nigricans ( WWW.WWWW.WW . Which, if true, seems to be related to gastric issues (which i may have), diabetes, or possibly other kinds of cancer. Is this something you would rule out? Thanks. -XXXXXXX
Answered by Dr. Indranil Ghosh 2 hours later

Thanks for writing back.

Acanthosis nigricans only over knuckles, without involvement of neck, armpits and groin is highly unlikely. These are the common sites. Your lesions also do not look like acanthosis nigricans.

If you cannot get the blood tests done, then it is OK to get those B12 injections. They won't do any harm.

There is no need to worry about other serious disorders.

I hope, this helps to solve your query. Please accept my answer in case you have no follow up queries.

Wish you good health.

Above answer was peer-reviewed by
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