No matter how well you take care of your skin, dark patches of skin on your knuckles can still appear. What could be going wrong?
Dark skin on the knuckles usually is a harmless skin condition. However, it might imply an underlying condition in some cases. You must identify the causes to determine the right treatment.
In this article, we help you understand the causes, know the effective treatments and preventive measures.
Our Ayurvedic Doctor Speaks
“It is normal to have dark knuckles caused by hyperpigmentation or due to UV exposure, poor skin care, environmental damage, genetics, etc. However, dark knuckles can also be a sign of certain underlying diseases or side effects of certain medications.’’
Dr. Zeel Gandhi (Bachelor of Ayurveda, Medicine & Surgery), Chief Ayurvedic Doctor, Vedix
What Are Dark Knuckles?
The skin at the knuckles region appears dark and thick due to hyperpigmentation, i.e, excessive production of melanin than usual in that region. More commonly, dark knuckles appear in people who have darker pigmentation in their skin.
Are Dark Knuckles Normal?
“It is normal to have dark knuckles caused by hyperpigmentation or due to UV exposure, poor skincare, environmental damage, genetics, etc . However, dark knuckles can also be a sign of certain underlying diseases or side effects of certain medications,” says Dr. Zeel Gandhi, Chief Ayurvedic Doctor at Vedix.
What Are Dark Knuckles A Sign Of?
If not hyperpigmentation, dark knuckles can be a sign of any one of the following:
- Reactions caused by certain drugs such as niacin, strong corticosteroids, or oral contraceptives.
- Metabolic disorders.
- Underlying conditions such as diabetes, autoimmune disorders, malignancy, etc.
- Hormonal-related disorders such as PCOS.
- Vitamin deficiencies.
Causes Of Dark Knuckles
Let us understand the most common causes of dark knuckles in detail below:
1. Acanthosis Nigricans (AN)
It is a genetic condition that involves the darkening of the skin in different areas of the body, including the knuckles . In this condition, the skin may have an odor and feels itchy.
“If someone develops Acanthosis nigricans suddenly then it can be an indication of cancer, particularly related to the liver, stomach, or colon,” says Dr. Zeel.
Risk factors of Acanthosis Nigricans:
- Family history of AN
- People who are resistant to insulin
Acanthosis Nigricans is often a warning sign of another underlying health condition such as diabetes.
In a study conducted by Primary care multi-ethnic network, it is revealed that about 19.4% of people develop Acanthosis Nigricans. Also, people with AN are twice as likely as those people without AN to develop type2 diabetes.
We often notice dark knuckles in people who already have diabetes or who are at the risk of having it soon . However, scientists have not completely understood the relationship between diabetes and dark knuckles.
3. Vitamin B-12 Deficiency
When your body is deficient in vitamin B-12, then you may develop dark knuckles. Sometimes, it may be the only sign of this deficiency . The knuckles may turn light or into normal skin tone once the deficiency is resolved.
Studies show that about 10% of people who have vitamin-B12 deficiency develop reversible pigmented knuckles.
Also, few patients who have megaloblastic anemia may also have dark knuckles.
4. Drug Reactions
The most common drugs  that can cause a reaction resulting in dark knuckles are:
- Niacin and nicotinic acid
- Growth hormone therapy
- Oral contraceptive pills
- Estrogen therapy
- Protease inhibitors
- Injected insulin
- Other nonsteroidal anti-inflammatory drugs (NSAIDs)
- Certain antibiotics such as tetracyclines
- Heavy metals
Usually, dark knuckles disappear once the drug consumption stops.
Please discuss with your doctor before taking any of the drugs mentioned above.
It is a rare inflammatory condition that results in skin rash on knuckles, face, elbows, knees, or chest along with muscle weakness. The knuckles may turn into a red to bluish-purple color when you have dermatomyositis .
6. Addison's Disease
It is an autoimmune condition in which the adrenal glands fail to secrete a sufficient amount of cortisol and aldosterone. When you have Addison's disease, the areas of scars or skin creases such as knuckles tend to turn dark during the initial days.
Also known as systemic sclerosis, Scleroderma is an autoimmune disease that results in the overproduction of collagen. This causes hardening and reddening of the skin and its connective tissues, including knuckles.
8. Raynaud's Phenomenon
When your body is exposed to extremely cold temperatures or stress, it causes contraction of the blood vessels in your fingers and toes, resulting in them becoming painful and blue .
9. Polycystic Ovary Syndrome (PCOS)
PCOS causes overproduction of male hormones in women. This imbalance of hormones causes the darkening of the skin in body creases such as knuckles.
“Treating PCOS with exercise, lifestyle changes, and drugs can eventually help you get rid of dark knuckles,” adds Dr. Zeel.
10. Autoimmune Disorders
Certain contactants such as paints, detergents, cleaning solutions can cause allergic reactions which result in dark knuckles.
How To Lighten Dark Knuckles?
You can treat the dark knuckles caused by hyperpigmentation effectively with the following treatments:
A. Home Remedies
1. Baking Soda
Pour little water into half a spoon of baking soda. Mix well and apply the paste to your dark knuckles. Leave it for 20 minutes and then rinse off with water. Do this once every day until the skin on your knuckles becomes light.
2. Lemon Juice
Add half a spoon of Sugar to a spoon of fresh lemon juice. Apply it on your dark knuckles and scrub gently for a few minutes. Leave it for 20 minutes and then wash it off using water. Do this twice a day until you see results.
3. Green Tea
Apply the green tea decoction to your dark knuckles twice a day for best results. Studies have found that green tea contains epigallocatechin gallate which acts as a tyrosinase inhibitor and helps in controlling pigmentation.
Apply soy milk on the dark knuckles using a cotton ball. Leave it for half an hour and then wash it off with water.
5. Almond+ Curd
Mix a spoon of almond powder with a spoon of curd. Exfoliate your knuckles with this mixture for 5-10 minutes gently. Leave it for half an hour and then rinse it off using water.
Massage a few drops of almond oil daily on the dark patches on the skin around your nails or knuckles on your hands and feet. This helps to treat severely rough and damaged skin of your knuckles.
B. Eat Healthily
Include lots of onion, eggs, legumes, garlic, other vegetables, and fruits that are particularly rich in vitamin C and minerals in your diet regularly to prevent dark spots on your skin. Also, drink sufficient water daily to keep your skin hydrated.
Eating eggs and dairy along with vitamin-B12 supplementation helps to reverse dark knuckles caused by vitamin-B12 deficiency.
You need to take vitamin-B12 supplementation only under the guidance of your doctor.
Vedix Tip: Quit smoking if you want to stop your knuckles from becoming dark. Studies revealed that cigarette smoking is directly linked with dark spots on the skin.
C. Ayurvedic Remedies
1. Ayurvedic Oils
Apply a few drops of the following oils in the morning and evening daily will help you get rid of dark knuckles naturally:
A. Kumkumadi Taila
Kumkumadi oil is ideal for pigmented, aging, and damaged skin. This oil is made of saffron which works great in repairing pigmentation.
B. Jwalini Taila
Jwalini oil contains different herbs that are processed in sesame oil and coconut milk. It is excellent for treating dark spots caused by sun exposure.
C. Nalapamaradi Taila
Nalapamaradi oil is made of Indian madder, turmeric, vetiver, gooseberry, and sesame oil. With rich antioxidants, it works as an effective de-tanning oil for your skin and minimizes the appearance of dark skin.
Add a few saffron strands to a pinch of turmeric. Add a little amount of water to it and make a paste. Apply the paste to your dark knuckles and wash it off after half an hour. Do this once every day.
Add sufficient orange juice to half a spoon of sandalwood powder to make a smooth paste. Apply the paste to your dark knuckles and wash it off after half an hour. Do this once every day.
4. Masoor Dal
Make a fine paste from soaked masoor dal. Apply it to your dark knuckles and wash it off after an hour. Do this once every day.
Prepare a fine paste by mixing a sufficient amount of water in half a spoon of turmeric. Apply the paste to dark knuckles and wash it off after an hour. Do it once every day.
Studies revealed that turmeric contains curcumin which effectively inhibits melanogenesis in the human body.
D. OTC Medications
Different OTC products such as serums, gels, creams, etc. with any of the following ingredients are recommended to treat dark knuckles:
1. Kojic acid:
It is a fungal derivative found in wood pulp. It helps in skin lightening.
2. Ellagic acid:
It is found in cherries, pomegranates, and strawberries naturally. It works to stop the excessive production of melanin in your pigmented skin.
3. Azelaic acid:
It inhibits melanin production and lightens the skin that is affected by hyperpigmentation.
It works to increase cell regeneration in damaged skin and control the dark spots caused by photoaging.
5. Glycolic acid:
It acts as a chemical exfoliator for your skin. It eliminates dark spots and evens out your skin tone over time.
6. 2% Hydroquinone:
It is an effective bleaching agent for your skin. However, it is not suitable for everyone. So, please talk to your doctor before using this ingredient for your skin.
It works to inhibit the transfer of melanin into the skin cells which in turn works to lighten the dark knuckles.
OTC products work differently for different skin types. So, please consult your doctor before using any of the OTC medications mentioned in this article.
How To Prevent Dark Knuckles?
In general, you can prevent the appearance of dark knuckles by moisturizing the area regularly followed by the application of sunscreen. Healthy skin is less likely to develop dark knuckles. However, you cannot do much to prevent the dark knuckles caused by the underlying medical conditions.
When To See A Doctor?
When your knuckles turn dark suddenly, then it is an indication of some serious condition that needs immediate medical attention. Also, consult your doctor immediately when you have dark knuckles associated with symptoms such as dizziness, pain, or fatigue.
The Last Word
Unless the dark patches of skin on your knuckles are caused by certain underlying medical conditions, you can treat them effectively using Ayurvedic remedies or OTC products. In other cases, you may consult a doctor to determine the cause and ge5 it treated accordingly. In either case, you can resolve the condition successfully over time.
At Vedix, we analyze your skin needs and customize an Ayurvedic skincare regimen that addresses your unique skin problems by balancing doshas.Know Your Dosha Now
1. Skin hyperpigmentation in Indian population: Insights and best practice (Sept-2016), Indian Journal of Dermatology
2. Acanthosis Nigricans (Aug-2021), StatPearls
3. Diabetes mellitus and the skin (Feb-2017), Anais Brasileiros de Dermatologia
4. Knuckle Pigmentation: A Clue to Systemic Illness (Dec-2016), Indian Journal of Hematology and Blood transfusion
5. Drug-induced hyperpigmentation (2004), Dermnetnz
6. Clinical Presentation and Evaluation of Dermatomyositis (Sept-2012), Indian Journal Of Dermatology
7. Raynaud's, National Heart, Lung and Blood Institute
8. A Case of Generalized Acanthosis Nigricans with Positive Lupus Erythematosus-Related Autoantibodies and Antimicrosomal Antibody: Autoimmune Acanthosis Nigricans? (Jan-2012), Karger Research
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