Finger pebbles: a common finding in diabetes mellitus.

Several authors have now described the relatively common occurrence of thickening of the skin on the dorsum of the fingers and hands in persons with diabetes mellitus, and skin thickening in these patients has been documented histologically for other body locations. To date, the presence of finger and hand skin thickening has been determined by an examination difficult to objectify--palpation and attempted tenting of the affected area. In a survey of sixty subjects with diabetes, it was found that forty-five patients (75%) have a visual marker for skin thickening, that is, a pebbly appearance of the knuckle and distal finger skin. Similar changes were present in eleven of control subjects (21%). A limited histologic study indicates that the epidermis and papillary dermis are primarily responsible for this thickening. A pebbly appearance of volar finger skin may be a more easily recognized marker of diabetic skin thickening.