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What Causes Dark Knuckles and How To Treat Them?

Are you worried about your dark knuckles and want to know what causes dark knuckles and how to treat them? If yes, then read below to know about some of the causes of dark knuckles and also know ways to treat them.

What Causes Dark Knuckles and How To Treat Them?

What Causes Dark Knuckles and How To Treat Them?

Dark skin on the knuckles could be due to many reasons. The darker pigmentation on the knuckles might be inherited or might be a drug reaction, especially if you are taking drugs like an oral contraceptive, or a strong corticosteroid or niacin.

Some underlying conditions, such as diabetes, can also cause dark knuckles. Such conditions are required to be treated.

Though dark knuckles occur more frequently in people with darker skin pigmentation, however, anyone at any age can develop the darker pigmentation on their knuckles.

Below we will take a look at some of the possible causes of dark knuckles and also talk about some of the treatments and home remedies for the same.

What Causes Dark Knuckles?

Dark knuckles could be a sign of a lot of health conditions. Dark knuckles can also be caused by Vitamin B-12 deficiency and also due to certain drug reactions. Below are some of the most common causes of dark knuckles.

Acanthosis Nigricans or AN:

Acanthosis nigricans or AN is a health condition that involves the darkening and thickening of the skin in any one or more areas of the body, which could also include the knuckles. The darkened skin might feel velvety and it might even feel itchy or have a bad odor.

Acanthosis nigricans is quite common. In a study of 2010, AN was diagnosed in about 19.6% of the participants of the study, in all age groups. As per the study, it was found that the condition of AN was more prevalent in Native Americans, Hispanic populations, and African Americans.(1)

Anyone can get Acanthosis nigricans, however, you are more at risk if you are overweight or obese, if you are insulin resistant, have a family history of Acanthosis nigricans, or if you are African American, Hispanic, or Native American.

Acanthosis nigricans, is sometimes inherited and might occur in healthy individuals. It is thought that the condition is related to mutations in a gene that involves fibroblast growth factor.(2) However, it is usually a symptom or a warning sign of one more condition like diabetes.

Vitamin B-12 Deficiency:

Another cause of dark knuckles could be vitamin B-12 deficiency. According to a study of the year 2016, it was found that darker pigmentations on the knuckles can be an important marker of Vitamin B-12 deficiency.(3) Sometimes this might be the only marker for this vitamin deficiency. Some other symptoms of Vitamin B-12 deficiency are anemia, fatigue, feeling light-headed or dizzy, shortness of breath, and certain neurological problems.

A case study of 2017 has reported that about 10% of people suffering from Vitamin B-12 deficiency have dark knuckles.(4)

When the vitamin B-12 deficiency is treated, the dark knuckles will go away and the skin on your knuckles would return to its normal color.

Prediabetes And Diabetes:

Dark knuckles are found to be most prevalent among people with diabetes or who have various risk factors for diabetes. Prediabetes is the condition when your blood sugar levels are higher than normal.

Prediabetes usually has no symptoms, so dark knuckles can be a warning sign. It is important since lifestyle changes can help in regulating your blood sugar levels and also prevent prediabetes from progressing and resulting in diabetes.

The link between dark knuckles and diabetes is not understood completely. It is thought that high levels of insulin might affect the growth of skin cells.


This is a rare inflammatory disease that can result in muscle weakness and also a skin rash. The skin rash can appear on your knuckles and also your face, knees, elbows, or chest. The rash is usually red or bluish-purple. At times, the skin rash can appear without any muscle symptoms.

Dermatomyositis is mostly common in children between 5 to 15 years of age, or adults in their late 40s to early 60s.(5) Though the symptoms can be treated, there is no cure for the condition.


Scleroderma is a rare autoimmune disease and is also known as systemic sclerosis. It is a condition when there is an overproduction of collagen. This results in the hardening and tightening of your skin and connective tissues. There are several types of scleroderma.

One of the most important symptoms of this autoimmune disease is a reddening of the skin, which includes the skin in your knuckles and hands.

Scleroderma is also linked to Raynaud’s phenomenon, which is generally an early symptom of scleroderma. In Raynaud’s phenomenon, the blood vessels in the fingers and toes contract and might turn painful and blue colored. This is basically in response to stress or cold temperatures.

Addison’s Disease:

Addison’s disease is a rare health condition that is caused by the failure of the adrenal glands to produce enough steroid hormones like aldosterone and cortisol.

Darkening of skin color and fatigue are the two most common symptoms of this diseased condition. The darker skin usually appears near scars or skin creases, like your knuckles. Symptoms of Addison’s disease can vary, but skin darkening usually precedes other symptoms.

About 1 in 100,000 people in the US have Addison’s disease. This condition generally affects people between 30 years to 50 years old.(6) Addison’s disease is treatable with drugs for managing symptoms.

Polycystic Ovary Syndrome Or PCOS:

Polycystic Ovary Syndrome or PCOS affects women where they experience the production of higher-than-normal levels of male hormones. One of the symptoms of PCOS might be the darkening of the skin, usually in body creases.

Polycystic ovary syndrome is treatable with medications and lifestyle changes, like exercise and weight loss.

Autoimmune Disorders Like Sjogren’s Syndrome or Lupus:

Autoimmune disorders occur when one’s immune system begins attacking the very cells and organs of the body that it is supposed to protect. Many autoimmune disorders can result in the darkening of the skin, as we talked about the disease of scleroderma earlier.

In rare cases, dark knuckles might also be associated with an autoimmune disorder like Sjogren’s syndrome or lupus.(7)

So, if you have dark knuckles you should consult with your doctor at the earliest possible.

Drug Reactions:

Some individuals might develop dark knuckles because of a drug that they might be taking. Some of the most common drugs that can cause dark knuckles include oral contraceptive pills, drugs used in growth hormone therapy, estrogen therapy, protease inhibitors, niacin and nicotinic acid, glucocorticoids, and injected insulin.

If you are taking any of these drugs and being affected with dark knuckles, you should talk to your healthcare provider and know about any alternatives for your drugs. We would, however, say that the darkening of knuckles usually disappears when you stop taking the drugs that might be causing dark knuckles.

How To Treat Dark Knuckles?

Below are some of the effective ways to treat dark knuckles.

Treating The Underlying Causes:

Treating dark knuckles usually requires treating the underlying cause. This is very much important to identify and address the underlying health condition that might be causing dark knuckles. So, you should consult your doctor at the earliest. Usually, the dark knuckles disappear when the underlying health conditions causing them are being treated appropriately.

For instance, attaining proper body weight and controlling the levels of blood sugar, will help in controlling various conditions like diabetes, prediabetes, and PCOS. This will ultimately help in removing the hyperpigmentation of the knuckles.

Similarly, taking dietary supplements for treating vitamin B-12 deficiency, or hormone replacement therapies may be required for treating disorders, such as Addison’s disease, or immunosuppressants might be essential for correcting other autoimmune disorders.

If the underlying conditions are ruled out and still you have dark knuckles, you can try other treatment methods, or home remedies to treat darker pigmentations in your knuckles. You should consult with your dermatologist or doctor about the best possible options for treating dark knuckles.

Home Remedies To Treat Dark Knuckles:

Some common home remedies to treat dark knuckles include the following.

Tea: You can use tea for lightening the darker skin areas. It has been shown through a 2015 study that epigallocatechin gallate or a compound present in black, green, and white tea, also inhibits tyrosinase and so it can help in lightening the dark knuckles.(8)

You can steep green tea in warm water and use the concoction on your dark knuckles directly. Alternatively, you can also apply a mixture of the tea leaves with rose water and milk to help lighten the darker pigmentation in your knuckles.

Turmeric: One more home remedy that you can try to treat dark knuckles is by using turmeric. Turmeric contains curcumin, which is known for its skin lightening effects. For using this remedy you should apply a paste of powdered turmeric in the water on the darker knuckles and leave it for a few minutes before you wash it off.

Almond: Almond is another home remedy that you can use for treating your dark knuckles. Almond is a rich source of Vitamin E, and this vitamin helps in lightening the skin. For using almond as a home remedy to treat dark knuckles, you should prepare a paste of almond powder in rose water and apply this paste on your dark knuckles every day to see the positive effects. Massaging almond oil on the knuckles can also help in treating the darker pigments on your knuckles.

Curd: Curd contains a high content of lactic acid, and this can be effectively used for lightening dark skin. You can use curd to treat dark knuckles. For using this as a home remedy you can apply curd on your dark knuckles and leave it for about 20 minutes before washing it off using warm water.

Baking Soda: Baking soda can also be used as a home remedy to treat dark knuckles. Prepare a paste of baking soda in water and apply the paste on your knuckles for 2 minutes in a circular motion. Now, wash it off and apply a moisturizer.

Apart from all the above home remedies for treating dark knuckles, you can also use moisturizers and sunscreen lotions regularly. Though sunscreen lotion and moisturizers won’t lighten the dark knuckles, they can help in preventing damage or irritation caused due to cold weather, sun, hot water, and chemicals.

Over-The-Counter Or OTC Remedies:

Over-the-counter or OTC remedies could also help in treating dark knuckles. Some commonly used OTC products for lightening the skin has hydroquinone or lipohydroxy acid, which is derived from salicylic acid.

A dermatological study has shown that some natural ingredients can aid in lightening the skin.(9) These natural ingredients that usually do not cause any skin irritation are Niacinamide, Soy, Ellagic acid, and Lignin peroxidase.

Niacinamide is the form of vitamin B-3 that works in lightening the skin and suppressing additional pigment from coming to the surface. The same is with soy. Ellagic acid is derived from cherries, strawberries, and pomegranates. This acid works to stop an enzyme that is required for the production of melanin or a skin pigment. Lignin peroxidase is an enzyme that is extracted from a fungus that is present in wood pulp. This enzyme can break down melanin and help in skin brightening.

The same dermatological study has found that natural ingredients like Arbutin, Kojic acid, and licorice extract could also help in lightening the skin. However, these ingredients might cause an allergic reaction. Arbutin is derived from plants like cranberries and blueberry plants, Kojic acid is derived from a fungus present in wood pulp, while licorice extract is available over the counter as Liquirtin.

According to another study of 2012, it was found that Aloe leaf extract is also a natural ingredient that might help us in skin lightening.(10) Thus, it can be used for treating dark knuckles.

Make sure that you read the labels on the products carefully so that you are aware of what types of ingredients are used in the skin lightening product for treatment of dark knuckles.

Prescription Treatment for Dark Knuckle:

Now, let us come toprescription treatment to treat dark knuckles. You should talk to your doctor about prescription topical remedies. Some of the commonly prescribed drugs for hyperpigmentation are topical vitamin D compounds, keratolytic like topical retinoids, and oral melatonin.

Recently other new prescription products are developed. The two most promising drug ingredients required for skin lightening are SMA-432 and 44-n-butylresorcinol.(11)

Make sure that you consult with your doctor about any appropriate treatment plan that would work best for you to clear up dark knuckles. Also, ensure to ask about any possible side effects from the OTC or prescription products.

How Can We Prevent Dark Knuckles?

It is usually impossible to prevent many of the underlying health conditions that might result in dark knuckles. However, one can prevent hyperpigmentation by using a sunscreen lotion before going outside.

Moreover, avoiding medicines that results in hyperpigmentation might also help. But, you should always talk to your doctor before stopping your medication.

When To See A Doctor?

Dark knuckles can usually be the result of an underlying health condition. If you suffer from persistent dark knuckles that do not improve with any of the home remedies, you should consult with your doctor without any delay.

Apart from this, if you wish to choose a cosmetic treatment like laser therapy for treating dark knuckles, you should consult with your dermatologist, as they can decide if the treatment would be the right choice for treating your dark knuckles.


Dark knuckles could be a common problem and it could be having an underlying cause, like diabetes, prediabetes, and so on. If you can treat the underlying condition, you can also get rid of the darker pigmentation on your knuckles. You can take care of dark knuckles by regular cleansing, applying sunscreen and moisturizers on your knuckles.

You can also take care of dark knuckles by using some home remedies and OTC products that we talked about earlier in the article.


Also Read:

Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:February 1, 2021

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