(Diabetic Finger Pebbling, skin pebbles, pebbled knuckles)

Huntley’s papules are multiple fine, minute papules, grouped in a miniature “cobblestone” pattern on the extensor surface of the fingers, on the knuckles, or on the periungual surface with a sandpaper-like, velvety appearance of the skin.

Skin thickening is a common finding in diabetic patients and finger pebbling (FP) is a sensitive, easy to recognize cutaneous sign of diabetes disease and an early marker of thick syndrome in diabetes mellitus.

Diabetic skin pebbling occurs in approximately 75% of patients with diabetes mellitus. Similar changes may occur in up to 21% of nondiabetic persons (on the knuckle and periungual skin of manual laborers, or on the radial side of the third digit of the dominant hand as a result of holding a pen. Normally, the skin of the ulnar side of the finger is noticeably smoother than that on the radial side. If both sides feel the same, it is likely that the person has diabetes mellitus.).

Although the exact pathogenesis is unknown, the nonenzymatic glycoxidation of collagen could well be the basic pathophysiologic mechanism.

The histologic picture of FPs shows: hyperorthokeratotic epidermis with enlarged dermal papillae, thickened and vertically oriented collagen bundles, few elastic fibers, and a mild perivascular inflammatory infiltrate.

An improvement of FPs can be expected with improved glycemic control.